Joseph Lail didn't get to watch his kids grow up.

The 43-year-old and his ex-wife divorced before his first two children were teenagers, and he says he missed out on some of their formative years as a result.

So, when he started dating his now-wife Alayna, who'd always wanted a big family, he said he'd be open to having more kids.

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"When Alayna and I got together, this was a second chance for me," Joseph said.

The only problem: Joseph had undergone a vasectomy almost 20 years before. The couple wasn't sure if the procedure could be reversed at this point; in fact, one doctor they met with, who was unaffiliated with Michigan Medicine, told them they'd be better off trying in vitro fertilization, commonly known as IVF.

But then Alayna came across the online profile of James M. Dupree, M.D., M.P.H., a urologist who specializes in treating male infertility and a clinical associate professor at Michigan Medicine. She was impressed with his credentials, including his fellowship in male reproductive medicine and surgery, which gave him training in advanced techniques like microsurgery.

Alayna's parents encouraged the Lails to get a second opinion, so Joseph and Alayna scheduled an appointment to meet with Dupree.

The preparation

Immediately, they say, their care experience was different.

"Everything just clicked," Alayna said. "There were no barriers. There was no burden compared to our first appointment with the other doctor."

Joseph and Alayna are both Deaf, and an American Sign Language interpreter was waiting for them when they arrived at U-M to help facilitate communication between them and Dupree. Michigan Medicine provides trained and certified medical interpreters who can translate more than 40 languages free of charge for patients.

"And then Dr. Dupree walked in, and he was so friendly and open-minded," Alayna said. "He answered all of our questions and addressed all of our concerns. He talked us through the process and even gave us 'plan B' — what a different surgery would look like."

During a vasectomy, a urologic surgeon creates a blockage in the tubes that carry sperm, known as the vas deferens, to keep the sperm from making it into the semen. In a vasectomy reversal, there are generally two options: reconnect the vas deferens back to itself or attach the vas deferens to the epididymis, a gland that stores sperm on the back of the testicle.

The second approach can be necessary if a patient has developed another blockage, which can happen if the vasectomy took place a long time ago. Since nearly two decades had passed since Joseph's original procedure, Dupree told Joseph and Alayna he might need this 'plan B' strategy, but he wouldn't know for sure until the operation.

"One of the things I always encourage patients considering a vasectomy reversal to do is to find a doctor who has the training, equipment and skills to be able to do both 'plan A' and 'plan B,' should either be necessary," Dupree said.

In addition, Dupree said, he might have to take one approach for one testicle and the other for the other one.

"I loved all the detail," Alayna said. "It gave me hope."

They also discussed the cost of the vasectomy reversal — a topic Dupree always brings up with potential patients since most insurance companies will not cover the procedure. But Dupree said he could connect the couple with financial counselors to discuss their options.

"Again, every little bit made it seem like it could work," Alayna said.

"I remember them having great questions," Dupree said. "I could feel the love between the two of them and their excitement about the possibility of building a family together."

The procedure

Alayna made an appointment with her doctor to ensure she could have a healthy pregnancy. Once she heard that she should be able to carry a baby to full term, Joseph scheduled his vasectomy reversal with Dupree for a few weeks later.

Alayna says the high quality of care and communication continued the day of Joseph's surgery.

"They typically don't allow spouses in the pre-op area, but they allowed me to be back there with Joseph," Alayna said. "That was really nice because we rely on each other for communication as well as the interpreter, so I was very, very grateful for that. And then Dr. Dupree was there with his team, so we got to know who was working on the team and their names, and that was really great for me because I knew who was taking care of Joseph in the surgery."

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Dupree was able to sew Joseph's vas deferens back to itself ("plan A") on both sides and open a route for Joseph's sperm, which now had a 90 to 95% chance of successfully making it into his semen. Joseph wasn't in any pain, and Alayna said the instructions about what he was and wasn't allowed to do as he recovered were very clear.

On their way home, the couple stopped by McDonald's to celebrate.

The pregnancy

Dupree cautioned the Lails that even with success of the vasectomy reversal, it might take six to 12 months for Alayna to get pregnant, given both the necessary healing time from the procedure and, simply, that it often takes time for a couple to conceive.

But, just two months later, Alayna's pregnancy test came back positive.

At first, she couldn't believe it. She bought four more pregnancy tests — and stared at four more plus signs.

She even had some blood work done to make sure. When her clinic sent her the results, she was watching Joseph compete in a cornhole tournament in Ohio.

"I let him know, and there was this big smile on his face," she said. "He was just so excited."

The couple sent Dupree a message through the patient portal letting him know their good news and thanking him for how he and his team engaged with them and made them feel comfortable and hopeful.

SEE ALSO: Thrive With Your Family: Having a Baby During a Pandemic

"I was thrilled," Dupree said. "I became an infertility specialist because it's a wonderful thing to be able to help people build their families, with whatever means they choose to build them. It's really hard to want to build a family and not be able to, and I'm happy we could help Joseph and Alayna build theirs while providing them with excellent care."

"My expectations were set 20 years ago, and that really informed how I was feeling," Joseph said. "I thought we were out of luck. But after everything worked out, I could get rid of all those preconceived notions. We want every parent who's had a vasectomy and is considering a reversal to have hope."

Baby Lail is due on May 19.

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