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When a problem in trying to conceive is male fertility, there are many potential interventions. It is always best to start with the simplest.

1. Boxers, not briefs. Probably the easiest intervention in male fertility involves underwear. Briefs hold the testicles closer to a man's body. Boxers allow them to dangle and avoid overheating, which may damage sperm quality.

2. Missionary position. Although position during intercourse is only important when the woman is fertile, the missionary position is best. The penis is placed so that ejaculation is in the direction of the recently released egg.

3. Think zinc. European research has found that zinc supplements may increase male infertility even when the man is not zinc-deficient. The studies used 66 mg of zinc per day. Zinc picolinate is best, and should be complemented with a second supplement that provides 1 to 3 mg of copper per day.

4. Be aware of B vitamins, especially folic acid. This B vitamin also enhances sperm counts in men who are not necessarily deficient in the vitamin. A typical dosage is 6 mg per day.

5. Avoid any products containing cottonseed oil (such as cooking oil, shortening, or margarine containing cottonseed oil). Cottonseed contains gossypol, which is being investigated for use as the basis of a male oral contraceptive pill.

6. If you smoke, quit. Smoking produces chemicals that interfere with the normal maturation of sperm cells. If you cannot quit smoking, then take 500 mg of vitamin C per day to help offset the fertility effects of tobacco use. This may also be helpful when there is second-hand tobacco exposure.

7. If fertility has been devastated by chemotherapy, consider treatment with the herbal formula hochu-ekki-to. This Japanese herbal formula has been extensively investigated in clinical trials as a treatment for men who have fertility issues as a result of chemotherapy with doxorubicin (Adriamycin). In one Japanese clinical trial, 51 per cent of men using the herbal formula had increased sperm counts, and 20 per cent of couples not doing anything else to enhance their chances of conception were able to conceive within a year. The formula seems to work by helping sperm survive to maturity in the tests. In the United States and Canada, the formula is available to doctors who order it from Honso, USA.

Finally, don't quit trying just because of a low sperm count. Even among men with a sperm count below 10 million per cc, 40 per cent are able to conceive.

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