Although the assumption is often that the difficulties lie with the female partner, in one third of cases there are problems with both partners, whilst in another third, the male is infertile. Sperm counts have dropped by as much as 50% between 1930 and 1990. There are many different aspects to this issue, many of which unfortunately seem to fall under the 'laugh it off... too embarrassing to talk about' heading.

ERECTILE DYSFUNCTION
The inability to achieve or sustain an erection does not mean that the sufferer is infertile, although the two conditions may coincide. Most causes of erectile dysfunction are physical, although psychological factors such as stress and depression may contribute. Unhappily, the physical condition inevitably causes psychological anxieties, which may then inhibit recovery. Worrying about your sexual performance is a sure-fire way of cramping your style!

Medical conditions that can promote erectile dysfunction include thyroid disorders, diabetes, high blood pressure and high cholesterol. Prostate problems may be a factor, as may atherosclerosis, where the arteries leading to the penis are clogged, adversely affecting the circulation. Falling levels of testosterone, an inevitable part of ageing, will not cause erectile dysfunction unaided, as very small amounts are sufficient for the proper functioning of the penis.

Many medicinal drugs and most recreational drugs, as well as alcohol, nicotine and caffeine, can potentially hinder male sexual function. Smoking is a particularly likely culprit, as it has such a bad effect on circulation. It may seem ironic that alcohol can impede sexual function when it is so often blamed for unwanted pregnancies! Nevertheless, it is implicated in impotence and infertility.

Ask your doctor about the side effects of any medication you are on. In the case of atherosclerosis or poor circulation, attention to diet and supplements such as vitamin E or a combination of the herbs Crataegus (Hawthorn) and Garlic will be useful. Ginkgo biloba is an excellent circulatory stimulant, which brings better blood supplies to the brain as well as the other extremities. Many men suffering from impotence find it is extremely helpful (and, at this time of year, it stops you getting chilblains as well!).

TOXICITY
It is not just the toxins we take in willingly that can be a problem. We are exposed unwittingly to many toxins in the environment, in our food and in our homes. Chemical fertilisers on the fields, growth hormones given to cattle that end up on our table, oestrogens in the water supply ?the list is daunting. It has been suggested that increasing levels of environmental oestrogens are partially responsible for lowered fertility rates in men.

The body has many ways of dealing with toxins, but adequate levels of certain nutrients are required in order for it to do so, and these are often lacking in Western diets. Antioxidants, found in fresh fruit and vegetables, protect the body (and sperm) from the free radicals that cause oxidative damage. Most antioxidants promote conception in other ways as well. Vitamin C prevents the sperm from clumping together in a way that hinders fertilisation. Cigarettes are prime destroyers of vitamin C, but even non-smokers benefit from vitamin C supplementation. Vitamin E helps prevent toxins from damaging the sperm membrane. Selenium improves sperm motility. Zinc, another antioxidant, is particularly important. Low sperm counts have been linked to low levels of zinc and essential fatty acids (EFAs). Healthy semen should be rich in EFAs and zinc supplementation seems to help raise testosterone levels. It is interesting to note that men with low zinc levels often find their libido is flagging.

Zinc levels have been found to be low in infertile men and, as a whole, Western populations tend to be low in zinc and EFAs.

With all this talk about protecting sperm, you might be forgiven for thinking them rare and precious fruit. In fact there are mind-boggling numbers of the little brutes. An average ejaculate can contain as many as 200,000,000 sperm! Only about 40 of these will make it to the egg, though. Before you despair at the thought of these odds, remember that it only takes one sperm to fertilise an egg and, as the human race has managed to multiply quite dramatically over the past few centuries, 40 sperm are obviously more than enough. The fewer sperm in the ejaculate, however, the fewer will make it to the egg.

A man will be considered to have fertility problems if his total sperm count is lower than 5 million per millilitre. They need to be live - there may be no living sperm in the semen. Quantity is not the only issue: quality matters too. Infertility will result if more than 50% of the total sperm are abnormal. Once present and correct, they need to be motile. This is where nutrients are so important, as they have direct effects on areas such as sperm motility, bringing such hope to infertile couples. Although many people are unwilling to hear that their lifestyle choices may impact on their chances of having children, it is the case that poor diet and habits such as smoking can have huge consequences. Smoking, for example, decreases sperm counts and sperm motility and is associated with abnormal sperm.

Other points to consider include the health of the genital area. Chronic prostatitis (an infection of the prostate) reduces the quality of the sperm. Infections in the urinary tract are not helpful and the sexually-transmitted disease, Chlamydia trachomatis, can reduce fertility. Symptoms of this latter infection are often hard to spot, but can involve pain and a burning sensation when urinating or ejaculating, much like cystitis. Echinacea is a good herb to use to ward off any infections and strengthen the body against both bacterial and viral attack. For the prostate, Saw Palmetto is a great favourite: easy to use, with no side effects.

The herb Damiana is thought to tone the whole male sexual system. Generally, make sure that the scrotal temperature is not artificially raised: avoid tight-fitting clothes and underwear. Some authorities recommend cold water on the scrotum, but whether that would be good for the sex life is a moot point... There will be more sperm in the ejaculate if it? been a while since the last time, so save it for ovulation.

Other supplements to bear in mind are the amino acids, arginine and carnitine. Carnitine improves both sperm counts and motility ?there is a direct link between levels of carnitine and sperm motility. It can be supplemented in the form of L-carnitine. Arginine is needed for the replication of cells and therefore for sperm formation. It is not, however, as effective as L-carnitine and is not beneficial where sperm counts are very low.

Overall, then, it seems that lifestyle can play a vital role in improving fertility levels. Lack of sleep, over or underweight, lack of exercise, poor circulation: these can all contribute to low fertility. Living the typical urban life, exposed to many environmental toxins, lacking fresh air and peaceful rest, smoking and drinking and keeping sleep at bay with mugs of coffee will damage your chances of conceiving. Look to your diet, as many positive changes can usually be made. Cut down on fried food, sugar, dairy products and heavily processed food. Avoid caffeine, alcohol and tobacco. Drink mineral water instead of tap water. Try to eat organic food whenever possible. Fish, such as herring, mackerel, salmon and sardines are full of those helpful EFAs. Fresh fruit and vegetables give you quantities of vital antioxidants. There? no point eating junk food that fills you up without giving you any nutrients. What? more, your body uses up valuable nutrients whilst processing junk food, so you end up with even fewer vitamins and minerals!

Making dietary and lifestyle changes may seem like a drag, but it will have positive effects on all areas of your life and health; after all, you?l need lots of energy if you?e going to be running around after a toddler!