Carnitine in the Treatment of Idiopathic Asthenozoospermia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XUE Yu ^1,2 , ZHANG Yangang ^1,3 , WANG Li ⁴ ,  LU Yiping ¹

1. Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China;2. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, China;3. Department of Urology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China;4. Chinese Evidence-based Medicine/ Cochrane Centre, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LU Yiping, Email: yipinglu@163.com

Keywords：

Carnitine; Asthenozoospermia; Male infertility; Systematic review

DOI：

10.7507/1672-2531.20090064

Video：

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Objectives 　To assess the effectiveness and safety of carnitine in the treatment of idiopathic asthenozoospermia.
Methods 　The Cochrane Library, MEDLINE, EMbase, and CNKI were searched between Jan 1995 and Dec 2006. Both English and Chinese studies were included in the review if they were randomized controlled trials (RCTs) involving men with idopathic asthenozoospermia who were treated with carnitine. Trial screening, data extraction, and quality assessment of included trials were conducted by method recommended by Cochrane Collaboration. Statistical analysis was conducted using RevMan 4.2.10 software.
Results　 Five RCTs involving 346 patients met the inclusion criteria, and 307 patients were included in the meta-analysis. The results showed that: after being treated with carnitine for 3 and 6 months, the difference of the patients’ partners’ spontaneous pregnancy rate between treatment group and control group was statistically significant with RR2.46 and 95% CI1.12 to 5.43 (Z=2.23, P=0.03). After being treated with carnitine for 3 and 6 months, the difference of forward motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 9.16 and 95%CI 0.14 to 18.18 (Z=1.99, P=0.05) and WMD 5.28 and 95%CI –4.45 to 15.01 (Z=1.06, P=0.29). After being treated with carnitine for 3 and 6 months, the difference of percentage of forward sperm motility between treatment group and control group was not statistically significant with WMD 14.56 and 95%CI –4.49 to 33.61( Z=1.50 ,P=0.13), and WMD 7.34 and 95%CI –5.93 to 20.61 (Z=1.08, P=0.28). After being treated with carnitine for 3 and 6 months, the difference of total motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 15.32 and 95%CI –1.34 to 31.98 (Z=1.80, P=0.07) and WMD 6.20, 95%CI –3.00 to 15.39 (Z=1.32, P=0.19).After being treated with carnitine for 3 and 6 months, the difference of percentage of total sperm motility between treatment group and control group was not statistically significant with WMD 2.97 and 95%CI –5.75 to 11.69 (Z=0.67, P=0.50) and WMD 4.48 and 95%CI-9.17 to18.14 (Z=0.64, P=0.52). After being treated with carnitine for 3 and 6 months, the difference of semen volume between treatment group and control group was not statistically significant with WMD –0.12 and 95%CI –0.55 to 0.30 (Z=0.57, P=0.57) and WMD 0.03 and 95%CI –0.38 to 0.45 (Z=0.16, P=0.87). After being treated with carnitine for 3 and 6 months, the difference of sperm concentration between treatment group and control group was not statistically significant with WMD 7.92 and 95%CI – 2.85 to18.68 (Z=1.44, P=0.15), and WMD 1.02 and 95%CI –5.09 to 7.14 (Z=0.33, P=0.74). Three RCTs reported that there were no serious side effects of carnitine during the treatment period.
Conclusions 　The available evidence indicates that spontaneous pregnancy rate would increase with carnitine therapy, while it is short of improvement of semen parameters. There is no serious side effect of carnitine. Because of lack of evidence, we cannot conclude that carnitine is effective in improving the prognosis of infertile patients with idiopathic asthenozoospermia. More high quality trials with large sample are proposed.

Citation： XUE Yu,ZHANG Yangang,WANG Li,LU Yiping. Carnitine in the Treatment of Idiopathic Asthenozoospermia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(3): 337-345. doi: 10.7507/1672-2531.20090064 Copy

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3.	selected cases of male factor infertility: A double-blind crossover.
4.	trial. Fertil Steril, 2003, 79(2): 292-300.
5.	randomized trial of the use of combined l-carnitine and l-acetylcarnitine.
6.	treatment in men with asthenozoospermia. Fertil Steril,.
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13.	of idiopathic asthenospermia: a randomized, double-blind, placebocontrolled.
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34.	sperm quality. Int J Fertil Womens Med, 2000, 45(3): 236-240.
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36.	Gynaecol, 2003, 23(6): 653-656.
37.	Evaluation of seminal carnitine as a marker of epididymal function.
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68.	Cohen GM, d’Arcy Doherty M. Free radical mediated cell toxicity by.
69.	Halliwell B. Biochemical mechanisms accounting for the toxic action.
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1. infertility. Urol Clin North Am, 2002, 29(4): 949-963.
2. 症. 第1版. 北京: 人民军医出版社, 2003. 36-39.
3. selected cases of male factor infertility: A double-blind crossover.
4. trial. Fertil Steril, 2003, 79(2): 292-300.
5. randomized trial of the use of combined l-carnitine and l-acetylcarnitine.
6. treatment in men with asthenozoospermia. Fertil Steril,.
7. 海第二医科大学学报, 2005, 25: 292-294.
8. 弱精子症有效性与安全性的多中心随机对照临床研究. 中华男.
9. 科学杂志, 2005, 11: 761-764.
10. randomized trial on the use of L-carnitine, L-acetylcarnitine,.
11. or combined L-carnitine and L-acetylcarnitine in men with.
12. idiopathic asthenozoospermia. Fertil Steril, 2005, 84(3): 662-671.
13. of idiopathic asthenospermia: a randomized, double-blind, placebocontrolled.
14. trial. Fertil Steril, 2006, 85(5): 1409-1414.
15. treatment of patients with asthenozoospermia or moderate.
16. oligoasthenozoospermia with high-dose vitamin C and vitamin E: a.
17. randomized, placebo-controlled, double-blind study. Hum Reprod,.
18. in post-gonadal maturation of mammalian spermatozoa. Hum.
19. Reprod Update, 1996, 2(2): 87-102.
20. Am Heart J, 1992, 123(6): 1726-1727.
21. infertile patients with prostato-vesiculo-epididymitis. Hum Reprod,.
22. acetylcarnitine on NADPH-induced lipid peroxidation of cardiac.
23. microsomes. Drugs Exp Clin Res, 1987, 13(8): 509-515.
24. oxygen species. Hum Reprod Update, 1999, 5(5): 399-420.
25. activity of caspases by L-carnitine and palmitoylcarnitine. FEBS Lett,.
26. DNA damage and cell death by activation of the sphingomyelin.
27. pathway. Proc Natl Acad Sci U S A, 1994, 91(1): 73-77.
28. treatment for blocking apoptosis and preventing skeletal muscle.
29. myopathy in heart failure. Am J Physiol Cell Physiol, 2002, 283(3):.
30. C802-810.
31. on prepubertal rat Sertoli cells. Horm Metab Res, 2000, 32(3): 87-90.
32. cell protein metabolism. Horm Metab Res, 2004, 36(4): 221-225.
33. in the seminal plasma of fertile and infertile men: correlation with.
34. sperm quality. Int J Fertil Womens Med, 2000, 45(3): 236-240.
35. quality and seminal plasma total carnitine in infertile men. J Obstet.
36. Gynaecol, 2003, 23(6): 653-656.
37. Evaluation of seminal carnitine as a marker of epididymal function.
38. Actas Urol Esp, 1989, 13(3): 181-184.
39. redox cycling chemicals. Br J Cancer Suppl, 1987, 8: 46-52.
40. of oxygen on living organisms: the key role of superoxide dismutase.
41. Cell Biol Int Rep, 1978, 2(2): 113-128.
42. assay for determining oxyradical scavenging capacity of antioxidants.
43. and biological fluids. Free Radic Biol Med, 1998, 24(3): 480-493.
44. capacity toward different reactive oxygen species in seminal plasma.
45. and sperm cells. Clin Chem Lab Med, 2003, 41(1): 13-19.
46. Siddiq FM, Sigman M. A new look at the medical management of.
47. 郭应禄, 李宏军. 男性不育症. 见: 郭应禄, 李宏军, 主编. 男性不育.
48. Lenzi A, Lombardo F, Sgro P, et al. Use of carnitine therapy in.
49. Lenzi A, Sgro P, Salacone P, et al. A placebo-controlled double-blind.
50. 李铮, 谷荣华, 刘勇, 等. 补充肉毒碱治疗少弱精子症疗效观察. 上.
51. 李铮, 陈国武, 商学军, 等. 左旋肉碱和乙酰左旋肉碱合用治疗少.
52. Balercia G, Regoli F, Armeni T, et al. Placebo-controlled doubleblind.
53. Sigman M, Glass S, Campagnone J, et al. Carnitine for the treatment.
54. Ro l f C, Co o p e r TG, Y e u n g CH, e t a l . An t i o x i d a n t.
55. Jeulin C, Lewin LM. Role of free L-carnitine and acetyl-L-carnitine.
56. Arduini A. Carnitine and its acyl esters as secondary antioxidants?.
57. Vicari E, Calogero AE. Effects of treatment with carnitines in.
58. Schinetti ML, Rossini D, Greco R, et al. Protective action of.
59. Ochsendorf FR. Infections in the male genital tract and reactive.
60. Mutomba MC, Yuan H, Konyavko M, et al. Regulation of the.
61. Jarvis WD, Kolesnick RN, Fornari FA, et al. Induction of apoptotic.
62. Vescovo G, Ravara B, Gobbo V, et al. L-Carnitine: a potential.
63. Palmero S, Bottazzi C, Costa M, et al. Metabolic effects of L-carnitine.
64. Caviglia D, Scarabelli L, Palmero S. Effects of carnitines on rat sertoli.
65. Matalliotakis I, Koumantaki Y, Evageliou A, et al. L-carnitine levels.
66. Gurbuz B, Yalti S, Ficiciolu C, et al. Relationship between semen.
67. Salinas Sanchez AS, Moreno Aviles J, Lopez Paredes A, et al.
68. Cohen GM, d’Arcy Doherty M. Free radical mediated cell toxicity by.
69. Halliwell B. Biochemical mechanisms accounting for the toxic action.
70. Winston GW, Regoli F, Dugas AJ, et al. A rapid gas chromatographic.
71. Balercia G, Armeni T, Mantero F, et al. Total oxyradical scavenging.
72. , 14(4): 1028-1033.
73. , 478(1-2): 19-25.
74. , 16(11): 2338-2342.
75. , 81(6): 1578-1584.

Chinese Journal of Evidence-Based Medicine

Carnitine in the Treatment of Idiopathic Asthenozoospermia: A Systematic Review

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