Assessment of Seminal L-Carnitine in Infertile Men with Varicocele

Document Type : Original Article

Authors

1 Andrology, Sexology & STIs Faculty of Medicine, Beni-Suef University

2 Andrology, Sexology & STIs Faculty of Medicine, Cairo University

3 Clinical and Chemical Pathology Faculty of Medicine, Beni-Suif University

Abstract

Introduction: Most studies that linked varicocele (Vx) with male infertility focused mainly on the testis affection, yet it was suggested that Vx can disturb also the epididymis that plays a central role in sperm maturation. Higher concentrations of L-Carnitine (LC) were reported in the human epididymis but few studies have investigated the relationship of seminal LC with male infertility associated with Vx. This study aimed to assess seminal plasma L-Carnitine (LC) levels in infertile oligoathenoteratozoospermic (OAT) patients with varicocele (Vx). Methods: Overall, 86 men were investigated. They were divided into; infertile OAT patients with Vx (n=45), infertile OAT patients without Vx (n=21), and fertile men (n=20) as controls. These cases were subjected to history taking, clinical examination, and semen analysis. Seminal LC levels were estimated by the colorimetric method. Results: The mean seminal plasma LC levels were significantly lower in infertile OAT patients with Vx (216.3 ± 57.1 ng/ml) compared to infertile OAT patients without Vx  (252.9 ± 62.9 ng/ml, P= 0.01), or fertile men (382.8 ± 63.6 ng/ml, P=0.001). Besides, the mean seminal plasma LC level exhibited significant decreases in infertile OAT patients of Vx grade III compared to Vx grade II cases, and in infertile OAT patients of bilateral Vx compared with unilateral Vx cases. Collectively, there was a significant positive correlation between seminal LC levels with sperm concentration, motility, and normal forms. Conclusion: Seminal LC levels are expressively reduced in infertile OAT patients with Vx influenced by an escalation of its grade and bilaterality.

Keywords

Main Subjects

References

  1. Punab M, Poolamets O, Paju P, Vihljajev V, Pomm K, Ladva R, et al. Causes of male infertility: A 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Hum Reprod. 2017; 32(1): 18-31.
  2. Mintziori G, Nigdelis MP, Mathew H, Mousiolis A, Goulis DG, Mantzoros CS. The effect of excess body fat on female and male reproduction. Metabolism. 2020; 107(6): 154193.
  3. Henkel R, Offor U, Fisher D. The role of infections and leukocytes in male infertility.  Andrologia. 2021; 53(1): e13743.
  4. Mintziori G, Kita M, Duntas L, Goulis DG. Consequences of hyperthyroidism in male and female fertility: pathophysiology and current management. J Endocrinol Invest. 2016; 39(8): 849-53.
  5. Vander-Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018; 62(12): 2-10.‏
  6. Roque M, Esteves SC. Effect of varicocele repair on sperm DNA fragmentation: A review. Int Urol Nephrol. 2018; 50(4): 583-603.‏
  7. D'Andrea S, Micillo A, Barbonetti A, Giordano AV, Carducci S, Mancini A, et al. Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest. 2017; 40(10): 1145-53.
  8. Pallotti F, Paoli D, Carlini T, Vestri AR, Martino G, Lenzi A, et al. Varicocele and semen quality: a retrospective case-control study of 4230 patients from a single centre. J Endocrinol Invest. 2018; 41(2):185-92.
  9. Mostafa T, Nabil N, Rashed L, Abo-Sief AF, Eissa HH. Seminal SIRT1-oxidative stress relationship in infertile oligoasthenoteratozoospermic men with varicocele after its surgical repair. Andrologia. 2020;52(1):e13456.
  10. Mostafa T, Rashed LA, Nabil NI, Osman I, Mostafa R, Farag M. Seminal miRNA relationship with apoptotic markers and oxidative stress in infertile men with varicocele. BioMed Res Int. 2016; 2016: 4302754.
  11. Jensen CFS, Østergren P, Dupree JM, Ohl DA, Sønksen J, Fode M. Varicocele and male infertility. Nat Rev Urol. 2017; 14(9):523-33.
  12. Ringseis R, Keller J, Eder K. Role of carnitine in the regulation of glucose homeostasis and insulin sensitivity: evidence from in vivo and in vitro studies with carnitine supplementation and carnitine deficiency. Eur J Nutr. 2012; 51(1):1–18.
  13. Ribas GS, Vargas CR, Wajner M. L-carnitine supplementation as a potential antioxidant therapy for inherited neurometabolic disorders. Gene. 2014; 533(2): 469–76.
  14. Bene J, Hadzsiev K, Melegh B. Role of carnitine and its derivatives in the development and management of type 2 diabetes. Nutr Diabetes. 2018; 8(1):8.
  15. Potts RJ, Jefferies TM, Notarianni LJ. Antioxidant capacity of the epididymis. Hum Reprod. 1999; 14(10): 2513-16.
  16. Agarwal A, Said TM. Carnitines and male infertility. Reprod Biomed Online. 2004; 8(4): 376-84.
  17. Sigman M, Glass S, Campagnone J, Pryor JL. Carnitine for the treatment of idiopathic asthenozoospermia: a randomized, double-blind, placebo-controlled trial. Fertil Steril. 2006; 85(5): 1409-14.
  18. Lenzi A, Sgrò P, Salacone P, Paoli D, Gilio B, Lombardo F, et al. Placebo controlled double blind randomized trial on the use of L-carnitine and L-acetyl-carnitine combined treatment in asthenozoospermia. Fertil Steril. 2004; 81(6): 1578-84. 
  19. Mongioi L, Calogero AE, Vicari E, Condorelli RA, Russo GI, Privitera S, et al. The role of carnitine in male infertility. Andrology. 2016; 4(5): 800-7.‏
  20. Hasson MA. The relationship between the use of L-Carnitine supplements and the male sub-infertility. Int J Pharm Qual Assur.2019; 10(4): 735-40.‏
  21. Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, et al. The effect of antioxidants on male factor infertility: the males, antioxidants, and infertility (MOXI) randomized clinical trial. Fertil Steril. 2020; 113(3): 552-60.
  22. Zhang X, Cui Y, Dong L, Sun M, Zhang Y. The efficacy of combined l-carnitine and l-acetyl carnitine in men with idiopathic oligoasthenoteratozoospermia: A systematic review and meta-analysis. Andrologia. 2020; 52(2): e13470.
  23. World Health Organization. WHO laboratory manual for the examination and processing of human semen, 5th ed. Geneva: WHO Press, 2010.
  24. Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update. 2015; 21(1):56-83.       
  25. Kim YS, Kim SK, Cho IC, Min SK. Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis. Korean J Urol. 2015; 56(2): 144-9.‏
  26. Matalliotakis I, Koumantaki Y, Evageliou A, Matalliotakis G, Goumenou A, Koumantakis E. L-carnitine levels in the seminal plasma of fertile and infertile men: correlation with sperm quality. Int J Fertil Womens Med. 2000; 45(3): 236-40.
  27. Gürbüz B, Yalti S, Fiçicioğlu C, Zehir K. Relationship between semen quality and seminal plasma total carnitine in infertile men. J Obstet Gynaecol. 2003; 23(6): 653-6. 
  28. De Rosa M, Boggia B, Amalfi B, Zarrilli S, Vita A, Colao A, et al. Correlation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins. Drugs R D. 2005; 6(1): 1-9.
  29. Sheikh N, Goodarzi M, Bab Al-Havaejee H, Safari M, Amiri I, Najafi R, et al. L-carnitine level in seminal plasma of fertile and infertile men. J Res Health Sci.  2007; 7(1):43-8.  
  30. Tang LF, Jiang H, Shang XJ, Zhao LM, Bai Q, Hong K, et al. Seminal plasma levocarnitine significantly correlated with semen quality. Zhonghua Nan Ke Xue. 2008; 14(8):704-8.
  31. Haseen Ahmed SD, Ahsan S, Iqbal T, Ahmed Burney SI. Relationship of seminal free L-Carnitine with functional spermatozoal characteristics: Results from an observational study conducted in a tertiary care hospital of Karachi, Pakistan. J Pak Med Assoc. 2017; 67(2): 280-4.
  32. Xu Y, Lu H, Wang Y, Zhang Z, Wu Q. Comprehensive metabolic profiles of seminal plasma with different forms of male infertility and their correlation with sperm parameters. J Pharm Biomed Anal. 2020;177(5): e112888.‏
  33. Roaiah MM, Mostafa T, Salem D, El-Nashar AR, Kamel II, El-Kashlan MS. alpha-1,4-Glucosidase activity in infertile oligoasthenozoospermic men with and without varicocele. Andrologia. 2007; 39(1):28-32.
  34. Vivas-Acevedo G, Lozano-Hernández R, Camejo MI. Varicocele decreases epididymal neutral α-glucosidase and is associated with alteration of nuclear DNA and plasma membrane in spermatozoa. BJU Int. 2014; 113(4): 642-9.
  35. Zhu B, Zheng YF, Zhang YY, Cao YS, Zhang L, Li XG, et al. Protective effect of L-carnitine in cyclophosphamide-induced germ cell apoptosis. J Zhejiang Univ Sci B. 2015; 16(9): 780-7.
  36. Lenzi A, Lombardo F, Gandini L, Dondero F. Metabolism and action of L-carnitine: its possible role in sperm tail function.  Arch Ital Urol Nefrol Androl. 1992; 64(2): 187-96.
  37. Modanloo M, Shokrzadeh M. Analyzing mitochondrial dysfunction, oxidative stress, and apoptosis: potential role of L-carnitine. Iran J Kidney Dis. 2016; 13(2): 74-86.‏
  38. Mostafa T, Anis T, Imam H, El-Nashar AR, Osman IA. Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele. Andrologia. 2009; 41(2):125-9. 
  39. Mostafa T, Rashed L, Nabil N, Amin R. Seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele. Urology. 2014; 84(3): 590-5.
  40. Lehtihet M, Arver S, Kalin B, Kvist U, Pousette A. Left-sided grade 3 varicocele may affect the biological function of the epididymis. Scand  J Urol. 2014; 48(3): 284-9.
  41. Sofimajidpour H, Ghaderi E, Ganji O. Comparison of the effects of varicocelectomy and oral L-carnitine on sperm parameters in infertile men with varicocele. J Clin Diagn Res. 2016; 10(4): 7-10.
  42. Mostafa T, Rashed L, Taymour M. Seminal cyclooxygenase relationship with oxidative stress in infertile oligoasthenoteratozoospermic men with varicocele. Andrologia. 2016; 48(2): 137-42.
  43. Alkan İ, Yüksel M, Canat H, Atalay HA, Can O, Özveri H, et al. Superoxide anion production by the spermatozoa of men with varicocele: relationship with Varicocele grade and semen parameters. World J Mens Health. 2018; 36(3): 255-62.‏
  44. Ashrafzade A, Sadighi-Gilani M, Topraggaleh T, Khojasteh M, Sepidarkish M, Borjian Boroujeni P, et al. Oxidative stress-related miRNAs in spermatozoa may reveal the severity of damage in grade III varicocele. Andrologia. 2020; 52(9): e13598.‏

Egyptian Journal of Medical Research
Volume 3, Issue 2
April 2022
Pages 243-252

Files

Share

How to cite

Statistics