A multifaceted approach to maximize erectile function and vascular health  David R. Meldrum, M.D., Joseph C. Gambone, D.O., M.P.H., Marge A. Morris, M. Ed., R.D., C.D.E., Louis J. Ignarro, Ph.D.  Fertility and Sterility  Volume 94, Issue 7, Pages 2514-2520 (December 2010) DOI: 10.1016/j.fertnstert.2010.04.026 Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Factors that promote and inhibit NO production. Fertility and Sterility 2010 94, 2514-2520DOI: (10.1016/j.fertnstert.2010.04.026) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 2 The level (mean ± SE) of red blood cell reduced glutathione in men with ED was significantly lower (P<.001) compared with men without ED (14). Fertility and Sterility 2010 94, 2514-2520DOI: (10.1016/j.fertnstert.2010.04.026) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Vasodilatation reflected by peripheral arterial tonometry (PAT) was significantly higher after 5 days of ingestion of flavinol-rich cocoa, and also acutely after a single exposure on day 5 (both P<.01). The increase was almost completely abolished by an inhibitor of NO production, NG-nitro-L-arginine methyl ester (L-NAME) (P<.004) (16). Fertility and Sterility 2010 94, 2514-2520DOI: (10.1016/j.fertnstert.2010.04.026) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions

Figure 4 In a group of infertile men, a combination of L-arginine and pycnogenol significantly increased semen volume, total sperm, % A motility, and % normal morphology (P<.001) (22). In men with erectile dysfunction, this same regimen significantly increased the serum levels of testosterone (P<.001) (23). Fertility and Sterility 2010 94, 2514-2520DOI: (10.1016/j.fertnstert.2010.04.026) Copyright © 2010 American Society for Reproductive Medicine Terms and Conditions