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In men's infertility the top two causes are almost universally sperm count and sperm quality. Male infertility can also result from vasectomy, blockage or inflammation of the epididymis (the tube that carries sperm from their origin in the testes to the prostate where they are mixed with seminal fluids), chemotherapy, steroids, hypothyroidism, hemochromatosis, cirrhosis of the liver, and chlamydia. Up to 90 per cent of cases of male infertility, however result from low sperm count and low sperm quality of medically indeterminate origins.

Just because it's very difficult to determine why male infertility occurs does not mean, however, that there is nothing that can be done about it. Let's look at some unconventional but scientifically sensible approaches to increasing sperm count and improving sperm quality that go beyond what men are usually offered at the doctor's office.

Increasing Sperm Count and Improving Sperm Quality Begins in the Brain.

The hormonal trigger to release sperm begins not in the testicles but in the brain. Sexual functions are mediated by the hypothalamic-pituitary-gonadal axis, a closed feedback loop from the testicles to the hypothalamus and pituitary gland in the brain.

Every 70 to 90 minutes the hypothalamus responds to various signals from the pituitary gland and the testicles by secreting gonadotropin-releasing hormone (GnRH). This hormone travels down a passageway from the hypothalamus to the pituitary, where it in turn stimulates the release of a number of hormones including follicle-stimulating hormone (FSH). This is the same hormone that stimulates ovulation in women, except in men it stimulates the process that creates sperm cells form the lining of the testicles.

Increasing Sperm Count May Require More Sleep and Less Stress.

The trigger for sperm creation, GnRH, is sensitive to other hormone levels, medications, and illness. GnRH does not send as strong a signal to the pituitary gland when testosterone levels are exceptionally high, which is why testosterone is of limited use in treating male infertility. This essential ingredient in the process of spermatogenesis is inhibited by stress hormones (or, more precisely, by corticotropin-releasing hormone, which stimulates the adrenal glands to release stress hormones). It is limited by opiates, including the opiates that occur naturally in wheat, beef, and dairy, and it is limited by the inflammation caused by illness. The sleep chemical melatonin, however, enhances the release of GnRH.

What is melatonin? Melatonin is an antidepressant, anti-aging, antioxidant sleep-inducing hormone that is manufactured from serotonin in the pineal gland of the brain. When the retinas of the eyes sense low light, the brain gets a signal that it is nighttime and time to sleep. Melatonin begins to cause drowsiness and gradually, over a period of 3 to 4 hours, lulls the brain into deep sleep.

If the retinas are never given complete darkness, however, the nighty-night signal never reaches the brain, and it enters deep sleep with much more difficulty. There is also less release of GnRH, which means the testes are signaled less strongly to produce new sperm. For some men, fatherhood literally involves the ability to sleep with the nightlight out. A team of researchers in the Andrology Department at the University of Cairo reported in the journal Andrology that all infertile men in their study had lower levels of melatonin in blood plasma and in semen than fertile men. They also found that the very lowest levels of melatonin were observed in men who had issues with both sperm count and sperm quality. Supplemental melatonin-always taken at bedtime to avoid daytime drowsiness-may by itself be enough to correct infertility in some men.

Increasing Sperm Count with Nutritional Intervention.

Certain other nutritional measures also help. Scientists at the University Medical Centre at Nijmegen in Holland reported in 2002 that even men who do not have a measurable nutritional deficiency in folic acid or zinc experience increased fertility after taking those nutrients as supplements daily for six months. The daily dosages were 66 mg of zinc and 5 mg of folic acid.

Some nutritional supplements support correction of specific aspects of male infertility. When male infertility is duet to athenospermia, or poor "swimming ability," L-carnitine may enhance fertility even without increasing sperm count. In a doctor-supervised clinical study, 100 men with sperm motility issues were prescribed 3,000 mg of L-carnitine every day for 120 days. At the end of the study, 75 per cent of cases of infertility due to athenospermia were improved enough to enable conception. The number of motile sperm in these 75 per cent of study volunteers increased anywhere from 26 to 37 per cent.

Folic acid and zinc are not the only supplements that may support male fertility. Other clinical studies have found benefits in L-arginine, calcium, coenzyme Q10, and vitamins B12, C, and E. The majority of scientific research supports the use of folic acid, zinc, and L-carnitine.

Certain other simple steps may also be quite important.

Cottonseed oil, which sometimes appears in cooking oils and margarines, is a source of gossypol, which is a male contraceptive. Any man attempting to increase his sperm count should wear boxer shorts instead of briefs and trunks instead of Speedos. It's also important to steer clear of hot tubs, hot baths, and tight-fitting pants. All of these measures keep scrotal temperature low and increase the production of live, viable sperm.