Effects of levo-carnitine in infertile men with asthenozoospermia: a randomized placebo-controlled trial
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20241421Keywords:
Effectiveness, Levo-carnitine, Infertile men, AsthenozoospermiaAbstract
Background: Infertility is defined as the inability of a sexually active couple to conceive within one year of regular unprotected coitus. Worldwide, it is estimated that 15% of couples are infertile; among them, the male factor is responsible for 50% of cases. This may be the sole underlying cause or a contributory factor to infertility. We aimed to assess the effects of a complementary treatment with a strong antioxidant (levo-carnitine) on sperm function and fertility of infertile men.
Methods: This was a randomized controlled trial study and was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh. during the period from July 2022 to June 2023. In our study, we included 72 infertile men presenting with asthenozoospermia. There were two groups-group A (Participants who received tab levo-carnitine 330 mg twice daily orally for three months) and group B (Tab placebo twice daily orally for three months)
Result: The majority of patients in both groups, 51% in group A and 49% in group B, were aged 30-40 years, with no significant difference in mean age (35.36±5.50 vs 34.50±5.50, p>0.05). Overall, 62.5% of patients reported primary sub-fertility. Levo-carnitine administration leads to significant improvements in sperm motility (15±2.68 vs. 36.58±5.16, p<0.05). In the case of placebo treatment, there were no significant improvements in sperm motility (13.91±5.53 vs. 16.36±1.19, p>0.05). We found that the comparison of TMC of both groups reflected statistically significant differences (p<0.05) before treatment and after treatment with levo-carnitine and placebo (6.40±2.87 vs 22.91±14.88) 5.64±3.96 vs 7.71±4.91).
Conclusions: Levo-carnitine treatment can lead to significant improvements in semen parameters, particularly in motility.
References
Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertility and sterility. 2002;77(5):873-82.
Rowe PJ, World Health Organization (eds). WHO manual for the standardized investigation, diagnosis, and management of the infertile male, Published on behalf of the World Health Organization by Cambridge University Press, Cambridge, UK; New York. 2000.
Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reproduct Biol Endocrinol. 2015;13:1-9.
Gudeloglu A, Parekattil SJ. Update in the evaluation of the azoospermic male. Clinics. 2013;68:27-34.
Colpi GM, Francavilla S, Haidl G, Link K, Behre HM, Goulis DG, et al. European Academy of Andrology guideline Management of oligo‐astheno‐teratozoospermia. Andrology. 2018;6(4):513-24.
Cooper TG, Noonan E, Von Eckardstein S, Auger J, Baker HG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Human Reproduct Update. 2010;16(3):231-45.
Paoli D, Gallo M, Rizzo F, Baldi E, Francavilla S, Lenzi A, et al. Mitochondrial membrane potential profile and its correlation with increasing sperm motility. Fertil Steril. 2011;95(7):2315-9.
Rajender S, Rahul P, Mahdi AA. Mitochondria, spermatogenesis and male infertility. Mitochondrion. 2010;10(5):419-28.
Aitken RJ, Gibb Z, Mitchell LA, Lambourne SR, Connaughton HS, De Iuliis GN. Sperm Motility Is Lost In Vitro as a Consequence of Mitochondrial Free Radical Production and the Generation of Electrophilic Aldehydes but Can Be Significantly Rescued by the Presence of Nucleophilic Thiols1. Biology of Reproduction. 2012;87(5):110.
Mukai C, Travis AJ. What sperm can teach us about energy production. Reproduct Domestic Animals. 2012;47:164-9.
Du Plessis SS, Agarwal A, Mohanty G, Van der Linde M. Oxidative phosphorylation versus glycolysis: what fuel do spermatozoa use? Asian J Androl. 2015;17(2):230-5.
Collins GG, Rossi BV. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract. 2015;1:11.
Somers CM. Ambient air pollution exposure and damage to male gametes: human studies and in situ ‘sentinel’ animal experiments. Systems Biol Reproduct Med. 2011;57(1-2):63-71.
Ford CE, Jones KW, Polani PE, De Almeida JC, Briggs JH. A sex-chromosome anomaly in a case of gonadal dysgenesis (Turner’s Syndrome). Lancet. 1959;1:711-3.
Bremer J. Carnitine--metabolism and functions. Physiolog Rev. 1983;63(4):1420-80.
Reuter SE, Evans AM. Carnitine and acylcarnitines: pharmacokinetic, pharmacological and clinical aspects. Clin Pharmacokinetics. 2012;51:553-72.
Steiber A, Kerner J, Hoppel CL. Carnitine: a nutritional, biosynthetic, and functional perspective. Molecular Aspects Med. 2004;25(5-6):455-73.
Vaz FM, Wanders RJA. Carnitine biosynthesis in mammals. Biochem J. 2002;361(Pt 3):417-9.
Shekhawat PS, Sonne S, Carter AL, Matern D, Ganapathy V. Enzymes involved in l-carnitine biosynthesis are expressed by small intestinal enterocytes in mice: Implications for gut health. J Crohn’s Colitis. 2013;7(6):e197-205.
Russo A, Acquaviva R, Campisi A, Sorrenti V, Di Giacomo C, Virgata G, et al. Bioflavonoids as antiradicals, antioxidants and DNA cleavage protectors. Cell Biol Toxicol. 2000;16:91-8.
Abdelrazik H, Sharma R, Mahfouz R, Agarwal A. L-carnitine decreases DNA damage and improves the in vitro blastocyst development rate in mouse embryos. Fertil Steril. 2009;91(2):589-96.
Balercia G, Regoli F, Armeni T, Koverech A, Mantero F, Boscaro M. Placebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and L-acetylcarnitine in men with idiopathic asthenozoospermia. Fertil Steril. 2005;84(3):662-71.
Dokmeci D. Oxidative stress, male infertility and the role of carnitines. Folia Medica. 2005;47(1):26-30.
Adewoyin M, Ibrahim M, Roszaman R, Md Isa ML, Mat Alewi NA, Abdul Rafa AA, et al. Male infertility: the effect of natural antioxidants and phytocompounds on seminal oxidative stress. Diseases. 2017;5(1):9.
Banihani S, Agarwal A, Sharma R, Bayachou M. Cryoprotective effect of l‐carnitine on motility, vitality and DNA oxidation of human spermatozoa. Andrologia. 2014 Aug;46(6):637-41.
Mehni NM, Ketabchi AA, Hosseini E. Combination effect of Pentoxifylline and L-carnitine on idiopathic oligoasthenoteratozoospermia. Iran J Reproduct Med. 2014;12(12):817.
Manssor AR, Al-Mahdawi ZM, Hadi AM. The effect of L-Arginine of treatment for infertile men on semen parameters. Tikrit J Pure Sci. 2019;24(5):1-4.
Lenzi A, Sgro P, Salacone P, Paoli D, Gilio B, Lombardo F, et al. A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia. Fertil Steril. 2004;81(6):1578-84.
