• Mistakes That Could Be Sabotaging Conception

    If you’re struggling to conceive, you’re not alone. In fact, somewhere around one in five couples is unable to conceive after a year of having unprotected sex. Fortunately, there are treatments that can help boost your fertility and allow you to have a child. First, though, make sure you’re not accidentally making these mistakes that could be sabotaging your odds of conception.

    • Putting the wrong things into your body: Smoking, drinking, and doing drugs can impede your fertility, and so can too much caffeine. There’s also evidence to suggest that women struggling with fertility issues can benefit from modifying their diet to include more fruits, vegetables, healthy fats, and plant-based protein, and fewer sugary, processed foods. There’s also research that shows a link between fast food consumption and delay in conception. And while fish can be a good source of protein, eating high-mercury fish can increase your risk of miscarriage and can negatively impact your baby’s brain should you be able to retain the pregnancy. While you’re watching what you eat, watch how you prepare and store food, too. Bisphenol-A, found in many common household items, can negatively affect fertility. Eat fresh food instead of packaged, store things in glass instead of plastic, choose glass containers over cans, and drink water out of glass or stainless steel bottles rather than plastic.
    • Gaining or losing too much weight: You might know that obesity is one of the primary causes of infertility, but did you know that underweight women can also have trouble conceiving? A healthy BMI, between 18.5 and 24.9, is your best bet for successful conception and a healthy pregnancy.
    • Using the wrong lubricant. Obviously, you’ll want to steer clear of lubricants that contain spermicide. However, there are often other ingredients that can negatively affect sperm motility. Look for a fertility-friendly lubricant designed with a pH balance that mimics your body’s natural state.
    • Having sex too little or too much. When you’re trying to conceive, it’s important to know when you actually ovulate. Knowing your cycle can give you a general idea, as long as you count back 14 days from the beginning of your cycle. However, ovulation test kits can help you achieve greater accuracy. However, it’s a mistake to have sex only on the day you ovulate. Your fertility window is actually about six days; it starts four days before you ovulate and ends two days after. Should you just go ahead and have sex every day, to increase your chances of hitting the right one? No, this is also a bad idea, because the man’s sperm count will be depleted and need time to rebound. Your best bet is to determine your window of fertility and have sex every other day during that time.
    • Doing too much or too little exercise. A sedentary lifestyle can keep you from conceiving as quickly as you’d like. On the other hand, women who participate in extreme exercise can disrupt their hormones and reduce their chances for conception. Your best bet is to shoot for 150 minutes of moderate exercise each week, starting slowly and increasing your pace gradually as you become comfortable with it.
    • Thinking this all only applies to the would-be mom. The health of the man in the relationship matters, too. Men trying to become fathers should follow the same guidelines about smoking, drinking, drugs, and diet, and maintain a healthy weight. It’s also wise to have a check-up, to make sure you’re healthy and ready to father a child.

    If you are struggling to conceive, we are ready to help. At the Center for Vasectomy Reversal, we love making the world better by helping people grow their families. We pride ourselves on helping men improve their fertility through uncompromising, concierge-level patient care. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, contact us through our website or call 941-894-6428.

     

  • How Stress Affects Semen Quality

    It’s long been understood that stress has an impact on a person’s health, so it comes as no surprise to learn that men’s reproductive health may be affected by stress. About 12 in every 100 couples in the United States struggles with infertility, and several studies over the past several years have established a link between poor semen quality and stress. Now, a new study is taking a closer look at both subjective and objective measures of stress to try to determine how it’s connected with semen concentration and sperm motility and appearance.

    Male infertility is the problem for about 40 percent of couples with fertility issues. The main cause of male infertility is sperm abnormality, including misshapen or immobile sperm or low sperm production. Sometimes, these abnormalities are caused by medical conditions, but they can also be caused by health and lifestyle factors.

    The new study, published in the journal Fertility and Sterility was conducted by researchers from the Rutgers School of Public Health in Piscataway, NJ and Columbia University’s Mailman School of Public Health in New York, NY. Between 2005 and 2008, researchers looked at 193 men between the ages of 38 to 49 who were a part of the Study of the Environment and Reproduction at the Kaiser Foundation Health Plan in Oakland, CA. The men completed a series of tests to measure stress levels, including workplace stress, stressful life events, and perceived stress. They also provided sperm samples, which were analyzed for semen concentration, sperm shape, and sperm movement (motility).

    According to the researchers, men who felt stressed had lower concentrations of sperm and more sperm that were misshapen or had impaired motility. Even after considering other factors, like a history of reproductive health or other health problems, life stress negatively impacted sperm quality. Interestingly, job stress did not have the same effect. However, men with stressful jobs had lower levels of testosterone, and unemployed men had a lower quality of sperm than even stressed-out men with jobs.

    The researchers don’t fully understand how stress affects semen quality, but they have some theories. It could be that stress triggers the release of glucocorticoids, steroid hormones which lower testosterone and dampen sperm production. Oxidative stress could also be a factor because oxidative stress in the body can degrade semen quality.

    What is known is that a man can improve his fertility, even under stress, with healthy lifestyle habits. Staying physically active and practicing stress-reducing relaxation techniques can help, as can eating a nutritious diet and maintaining a healthy BMI. Men who are trying to improve their fertility should quit smoking, limit alcohol consumption, and talk to a doctor before beginning any new medication.

    At the Center for Vasectomy Reversal, we pride ourselves on helping men improve their fertility through uncompromising, concierge-level patient care. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, contact us through our website or call 941-894-6428.

  • How to Increase Male Fertility

    If you and your partner are struggling to conceive a child, you’re not alone. About one in six couples struggles with infertility, and one in three cases is due to a problem with male fertility. There are some natural remedies you can try, though, that may boost your chances of conception.

    • Load up your diet with healthy foods. Eat plenty of fruits and vegetables, focus on getting antioxidants and healthy fats. Limit your intake of saturated fats and red or processed meat. And be careful about eating soy, because it contains plant estrogen, which can reduce testosterone bonding and sperm production.
    • Take your vitamins and minerals. Though the mechanism behind it is not completely understood, research indicates that vitamin D and calcium can impact sperm health. Vitamin C improves fertility by relieving oxidative stress in the body. Additionally, limited studies suggest folate and zinc can improve sperm concentration, count, and overall health.
    • Quit smoking. Smoking is bad for every part of the body, so it should come as no surprise that it’s bad for your fertility. In fact, recent research indicates that smoking consistently reduces sperm count and people who smoked moderate or heavy amounts of tobacco had lower sperm quality than non-smokers or even light smokers.
    • Watch the alcohol and drugs. Don’t drink to excess, don’t do any illegal drugs, and be mindful of your prescriptions. Some antibiotics, anti-androgens, anti-inflammatories, antipsychotics, opiates, antidepressants, anabolic steroids, supplementary testosterone, and methadone can all negatively affect your fertility. If you’re concerned about a medication you’re taking, talk to your doctor.
    • Keep your cool. High temperatures can damage sperm, so if you’re trying to conceive don’t hold your laptop in your lap, wear tight underwear, or soak in hot tubs. Prolonged sitting and using car seat heaters can also cause overheating.
    • Consider a supplement. Certain herbal supplements may be beneficial to fertility, including fenugreek, maca root, tribulus terrestris, and Indian ginseng. D-aspartic acid, a type of amino acid, may also be helpful.
    • Reduce your exposure to environmental contaminants. Poor air quality and environmental toxins have been shown to decrease male fertility. Additionally, men in jobs with exposure to chemicals and overheating, like farmers, painters, varnishers, metalworkers, and welders, had higher incidences of infertility than other groups.
    • Manage your stress. Stress raises cortisol levels, and cortisol lowers testosterone.
    • Get some exercise and some sleep. For each, the key is to get just the right amount- not too little and not too much. Getting enough exercise and enough rest can improve your sperm count. It can also help you lose weight, which can improve your fertility.

    If you’re struggling with infertility, call the Center for Vasectomy Reversal, where we love helping people build their families! We pride ourselves on providing optimal surgical results and uncompromising, concierge-level patient care. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, call 941-894-6428 or contact us through our website.

  • Help Getting Pregnant: Things You and Your Partner Can Do

    The journey into parenthood can be emotionally charged. Once you and your partner are ready to conceive, follow these tips to increase your fertility.

    Know Your “Fertile Window”

    A man’s sperm is most likely to reach a woman’s fertile egg on ovulation day and the five days leading up to it. Most women ovulate about 12 to 16 days before starting each period, so track your menstrual cycle on a calendar to help you better predict when you might be ovulating. Then, have sex with your partner every other day during this six-day “fertile window.”

    Maintain a Healthy Body Weight

    Being overweight makes it harder to get pregnant, but so does being underweight. Strive for a body max index (BMI) in the “normal” range of 18.5 to 24.9. At the same time, don’t exercise too much. Strenuous physical activity could interfere with ovulation, so work with your doctor to determine a moderate exercise plan that will work for you.

    Eat a Balanced Diet

    In addition to helping you achieve a healthy weight, eating a balanced diet provides your body with fertility-promoting nutrients. While trying to get pregnant, eat more:

    • Fruits and vegetables
    • Lean protein
    • Whole grains
    • Lentils and beans

    Then, eat less:

    • High-mercury fish
    • Soda
    • Caffeine
    • Trans fats

    Take Prenatal Vitamins

    It doesn’t hurt to start taking prenatal vitamins as soon as you start trying to conceive. Finding a prenatal vitamin that agrees with your system now makes it easy to stay on it during pregnancy. Choose a supplement that provides at least 400 micrograms (mcg) of folic acid to promote healthy brain and spine development in your future fetus. Dietary sources of folic acid include leafy greens, broccoli, beans, citrus fruits, orange juice, and fortified cereals.

    Stop Smoking and Drinking

    Smoking causes fertility issues in men and women alike. Even secondhand smoke can affect the chances of becoming pregnant, so keep away. Also, because alcohol consumption can cause birth defects, a sexually active woman should stop drinking as soon as she goes off birth control. Cannabis and other recreational drugs should be avoided as well while trying to conceive.

    De-Stress

    Research shows that high stress levels make it more difficult to get pregnant. Of course, relaxing is easier said than done. Try reducing stress in your daily life with these tips:

    • Take a walk.
    • Learn deep breathing exercises.
    • Get plenty of sleep.
    • Find activities that make you smile and laugh.
    • Try yoga or meditation.
    • Go on vacation.
    • Catch up with an old friend.
    • Avoid overbooking yourself.

    At the Center for Vasectomy Reversal, we love helping men and women become parents. If you’re ready to begin your journey into parenthood, consider a vasectomy reversal performed under the direction of Dr. Joshua Green. Our state-of-the-art clinic in Sarasota, FL provides a comfortable setting to receive your fast, effective procedure. To learn more, please call us at 941-894-6428 or schedule your free consultation online.

  • Can COVID-19 Affect your Reproductive Organs?

    Information about COVID-19 continues to evolve, and we learn new things about it all the time. Because we know that seasonal flu and other viruses with high fevers tend to negatively impact male fertility, there’s been concern that this may be true of COVID-19 as well. Recent evidence seems to indicate that this concern is valid.

    One reason that viruses are thought to be harmful to a man’s fertility is that high fevers heat the testicles and damage sperm. For weeks or even months after recovering from influenza, for example, patients may experience abnormal sperm as well as a decrease in sperm count, motility, and genetic health. Since a major symptom of COVID-19 is a high fever, it’s not a leap to assume that the same will be true of that illness. Fortunately, though they may linger, the affects of a fever on male fertility are still temporary and fully reversible.

    The information we have about COVID-19, however, is still evolving. Because we’re in the early days of understanding this illness, it could be a long time before we truly understand who is at risk, how and when problems develop, how quickly they resolve, and whether they persist. There are a few different aspects of COVID-19 that researchers are looking at closely in regard to male fertility.

    A big question is whether the virus gets into the testicles. If it does, then the question becomes one of how long it remains and how much it damages the cells that produce sperm and testosterone. Recent research done by American, Chinese, and European scientists indicates that many COVID-19 patients have significant testicular cell damage without the virus actually being present in the testicles themselves. How could this be?

    One thing raising concerns among researchers is the protein enzyme to which the coronavirus binds, known as ACE2. This enzyme is on the surface of many cells in the blood vessels, heart, lungs, kidneys, gastrointestinal tract, and reproductive orders, and it provides a gateway for the virus to infect these cells. Because the testes have high levels of ACE2, they’re likely to be affected. Studies have demonstrated that the virus affects hormone levels, diminishes sperm quality and concentration, and can reduce semen volume.

    The good news it that COVID-19 does not seem to be sexually transmittable. As to long-term effects, there’s no way to know at this point whether the damage done by the virus is reversible. For men who have had COVID-19, it’s advisable to see a urologist about any reproductive concerns.

    If you’re interested in reversing your vasectomy and you’re looking for an experienced professional surgical team, the Center for Vasectomy Reversal is here for you. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, contact us through our website, or call 941-894-6428 for a free consultation.

  • Celebrity Infertility Spotlight: Chrissy Teigen and the Heartbreak of Miscarriage

    Some celebrities are deeply protective of their privacy when it comes to their personal lives. Chrissy Teigen and John Legend are one couple who have been extremely open about theirs. They’ve talked openly about their struggles with infertility and IVF, and earlier this year shared their joy over a surprise pregnancy. Sadly, that pregnancy has ended in a miscarriage. Teigen has been candid about her devastation over the end of the pregnancy as well, and there’s something very beneficial about someone being so willing to share her joy and pain. It helps other women going through the rollercoaster ride of infertility know that they are not alone.

    Infertility affects about one in eight people. Often, it’s difficult to even discern the problem, and certainly, Chrissy Teigen’s experience illustrates this. Young and healthy, with a healthy husband, she struggled for years before undergoing IVF. In vitro fertilization is emotionally stressful and physically taxing, involving lifestyle changes, medications, and seemingly endless procedures. It doesn’t always work and sometimes ends in miscarriage. What’s more, many women go through this experience feeling alone because infertility is a taboo topic.

    Something else that’s taboo is miscarriage, though it’s an experience shared by as many as one in four women. For Chrissy Teigen, it happened at the end of last month. When celebrities are open about their joys and pain, it helps open dialogue about difficult topics. If you’ve suffered a miscarriage, there are a few things to remember.

    • It’s ok to talk about it. Talking about it can be beneficial, not just for you but for others. It may surprise you to discover how many people you know have had similar experiences. The loss of a pregnancy is an isolating event but talking about it can help you heal.
    • Take the time to grieve. It can be hard to cope after a miscarriage, and some feelings of grief can resurface much later, particularly on the anniversary of the loss or what would have been the baby’s birthday. Doing something meaningful to honor your baby may bring you some peace.
    • Be gentle with each other. You and your partner will go through this together, even if you feel like you’re going through it alone. Men sometimes don’t want to talk about things like this, but it doesn’t mean they don’t feel them deeply. After their miscarriage, John Legend wrote of the experience, “What an awesome gift it is to be able to bring life into the world. We’ve experienced the miracle, the power and joy of this gift, and now we’ve deeply felt its inherent fragility.”

    At the Center for Vasectomy Reversal, we’re committed to helping people build their families. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, contact us through our website, or call 941-894-6428 for a free consultation.

     

  • Should you put pregnancy on hold because of COVID19?

    The COVID-19 has changed a lot of plans for a lot of people. Schools and businesses have closed, gatherings have been cancelled, and many people are quarantining at home. If you’ve been trying to start a family, should that plan be changed as well? The decision about whether or not to put your pregnancy on hold during the pandemic is multifaceted and, ultimately, deeply personal and subjective.

    It’s important to acknowledge that there’s no right answer to this question. Everyone family’s circumstance is different, and each couple has to decide for themselves when it’s the right time to have a baby. There’s not even really a scientific consensus on this issue. There are, however, a few different factors to consider.

    • First, consider your age. If you’re young and have plenty of time to get pregnant, there may be no rush to go ahead and do it now, during this uncertain time. If you’re nearing the end of your childbearing window, however, it may be worth pressing ahead.
    • Think about what you do for a living. If you work from home, there may be very little risk of you contracting the virus. If you’re working in a high-risk setting, however, this may not be such a good time. Even if you’re not on the front lines of the virus, if you’re the primary breadwinner and your employer won’t allow you to work remotely, you may consider waiting to get pregnant.
    • What are your risk factors? If you’ve got a history of high-risk pregnancies, or if you have underlying medical conditions that put you at higher risk of contracting COVID-19, you should not consider pregnancy at this time. It’s important to discuss your risk factors with your doctor, so that you can make an informed decision.
    • The pandemic is limiting medical care. Many medical practices are moving to virtual or telephone visits, and this is not ideal for prenatal care. Further, reallocation of medical resources may limit your access to care during your pregnancy. Doctors are restricting elective procedures, and this applies to fertility treatments as well. Back in March, the American Society for Reproductive Medicine (ASRM) issued new guidelines restricting assisted reproduction, so while you can still become pregnant naturally, your other options are limited.

    Here’s another question: does COVID-19 pose risks to the pregnancy or the baby? The answer is not entirely clear. There have been some small studies indicating the babies can contract COVID-19 from their mothers in utero. However, the babies studied all recovered quickly, as the virus seems to typically impact small children less severely than adults.

    At the Center for Vasectomy Reversal, we love helping people build their families. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other fertility concerns. To learn more, contact us through our website, or call 941-894-6428 for a free consultation.

     

  • Fertility Myths that Should be Left in the Last Decade

    As we move into a whole new decade, with exciting new medical technology and new scientific discoveries making the news all the time, you’d think we’d leave old myths by the wayside. It’s surprising to note, then, that some people still believe a number of untrue things about healthcare. Fertility, in particular, is plagued by persistent myths. Have you fallen for any of these? It’s time to shake them off and move forward.

    • Menstruation is connected to the moon. The idea that a woman’s cycle and the lunar cycle is a fairly popular notion. It’s easy to see why: menstrual cycles are typically about 28 days, and the moon’s cycle, from new moon to new moon, is about 29.5. There’s no evidence, however, to suggest that this is more than coincidence. If there was a moon-menstruation connection, what purpose would that serve?
    • To become pregnant, lie down after sex. It’s widely believed that lying down for a certain period of time after sex can increase your odds of conception. In fact, there’s no evidence that remaining prone is helpful at all: after sex, the sperm likely to fertilize the egg have already gotten where they need to go.
    • Menopause is unnatural. Some people believe that women were never meant to go through menopause, because for much of history women did not live long enough to experience it. This myth comes from the idea that women’s value is tied up in reproduction. In fact, even in the 17th century, women lived an average of 60 years. Men didn’t live much longer than that, but society wasn’t as interested in their reproductive function and its decline.
    • The female orgasm promotes conception. In order for a female orgasm to propel sperm, it would have to happen at the same time as the male orgasm, and that’s rare.
    • The HPV vaccine causes premature ovarian failure. The human papillomavirus vaccine is somewhat controversial, and in the vaccine literature, there was mention of six cases of premature ovarian failure. However, a much larger study disproved the connection with the vaccine.
    • Men are forever fertile. Though some men can father children in their old age, for most men fertility declines with age, and there’s a marked decline in the success of fertility treatments for men over 50.

    If you’re considering a vasectomy reversal, the Center for Vasectomy Reversal is here to help. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other concerns about their fertility. We accept major credit cards as well as cash and checks, and offer a payment plan for those who are unable to pay the entire fee at the time of surgery. Whether you’re ready to schedule a procedure or just want to learn more, you can contact us through our website, or call 941-894-6428 to arrange a free consultation.

  • Five Fast Facts about Vasectomy Reversals

    A vasectomy is considered a permanent method of sterilization, but is it really permanent? Between six and ten percent of men who have had vasectomies will change their minds at some point and consider a vasectomy reversal. In truth, even though in times past it was a long shot, today vasectomy reversal is extremely doable. Here are some things you might want to know about this increasingly common procedure.

    1. Vasectomy reversal is a largely successful outpatient procedure. When a vasectomy is performed, the surgeon reroutes or clamps the internal tubing that carries sperm from the testicles through the penis. This tube, called the vas deferens, is restored in a vasectomy reversal. Using microsurgery techniques that involve surgical microscopes and stitches finer than a human hair, the doctor re-attaches the tubing. It only takes about two hours, and the patient can usually go back to work in a day or two.
    2. A man’s testicles never stop making sperm. A vasectomy prevents sperm from leaving the body, but it doesn’t stop sperm production. Therefore, once the reversal is complete, normal fertility is restored. After three weeks or so of abstinence, to allow for healing, the couple can try to conceive.
    3. Time is a factor in vasectomy reversal success, but it may not be the biggest factor. The rates of success for a vasectomy reversal are as high as 95 percent for vasectomies done within the past 10 years. After 15 years, the success rate begins to decline, but the health of the man’s sperm and the age of the female partner are just as significant in the chances of conception.
    4. Fertility plays a role, even after a successful reversal. Before a man goes through a vasectomy reversal, he and his partner should be examined for fertility issues as well as overall health. Sometimes, the best option for conception is in vitro fertilization, so the doctor may recommend a sperm retrieval to increase the chances of conception.
    5. Insurance probably doesn’t cover the procedure. It’s important to note, before deciding to undergo a vasectomy reversal, that it’s typically not covered by insurance. Therefore, patients need to be prepared to pay out of pocket.

    If you’re considering a vasectomy reversal, the Center for Vasectomy Reversal is here to help. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other concerns about their fertility. We accept major credit cards as well as cash and checks, and offer a payment plan for those who are unable to pay the entire fee at the time of surgery. Whether you’re ready to schedule a procedure or just want to learn more, you can contact us through our website, or call 941-894-6428 to arrange a free consultation.

  • New Research about Infertility is Promising

    One in eight couples has trouble conceiving. Do you know how many of the cases are caused by unexplained male infertility? Nearly a quarter. For years, scientists have known that infertility can be linked to sperm that fail to throw out histones from DNA during development, but the reasons for this failure and how it happens is unclear. Now, however, that lack of clarity may be changing.

    Promising new research out of Penn Medicine is showing the precise location of the retained histones and the key gene that regulates them. Researchers have also created a mouse model with a mutated version of the gene. This allows investigators to track the defects in sperm, starting with the early stages of sperm development and going through fertilization. This research could lead us to a better understanding of infertility in men, and how epigenetic mutations are passed to future generations.

    What does it mean, when sperm fail to evict histones?  Histones are the main proteins in chromatin. Their function is to package DNA and turn genes on and off. Healthy sperm lose about 90-95 percent of these proteins, replacing them with protamines, smaller proteins able to pack DNA into tiny sperm. When a man has unexplained infertility, the problem is often with retained histones. The sperm count can be normal, the sperm have normal motility, and yet because the histones are in the wrong location, the couple has trouble conceiving.

    Until now, research has produced conflicting results about where these histones are located. Because of the confusion of discrepant data, the burden of assisted-reproductive technologies has continued to fall on women. Even if the male has the issue, the female partner goes through hormone injections and procedures to promote a higher fertility rate.

    Imagine, then, if scientists were able to use epigenetic therapies to change the levels of histones and protamines in men. With this new research, scientists are better able to closely study the mechanisms behind a mutated sperm’s trajectory, which opens the door to potential therapeutic treatments. Epigenetic drugs are already being used to treat cancer and other diseases. With a clearer understanding of how a man’s epigenome affects conception and embryonic development, we have the potential to alter sperm, so these new studies may lead to a breakthrough infertility treatment.

    If you’re struggling with infertility or considering a vasectomy reversal, the Center for Vasectomy Reversal is here to help. Under the direction of Dr. Joshua Green, our team provides state-of-the-art treatment for men who need a reversal of their vasectomy or have other concerns about their fertility. We accept major credit cards as well as cash and checks, and offer a payment plan for those who are unable to pay the entire fee at the time of surgery. Whether you’re ready to schedule a procedure or just want to learn more, you can contact us through our website, or call 941-894-6428 to arrange a free consultation.