ROLE OF MICRONUTRIENTS IN INFERTILITY, ROLE OF CARNITINE BY DR SHASHWAT JANI

1. Dr. Shashwat Jani.
M. S. ( Obs – Gyn )
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : 99099 44160.
E-mail : drshashwatjani@gmail.com

2. Introduction
Many studies and researches have proved
that there is a strong positive relationship
between Micronutrients & fertility.
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3. • In order to examine the association
between micronutrients and infertility, articles
with case-control, descriptive, cohort, and
interventional (clinical trials) design, published
between 1984 and 2014, were accessed
through PubMed and Embase databases,
using keywords such as “micronutrients “ ,
"oxidative stress", "antioxidant", "vitamins",
"minerals", and "infertility“….
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4. 22-Aug-16 Dr Shashwat Jani 99099 44160. 4

5. Male Infertility
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6. Nutritional Considerations
• Various micronutrients are
associated with male fertility.
• Deficiency of these
micronutrients may result in
infertility.
Nutritional
Factors
Free radical
scavengers
L-Carnitine Lycopene
Coenzyme
Q10
Vitamin C
Zinc Vitamin E
Arginine Glutathione
Vitamin
B12
Selenium
Altern Med Rev. 2000;5(1):28-38.

7. Role of Micronutrients in Male Fertility
Nutrition plays vital role in maintaining male fertility:
Involved in the successful maturation of sperm
Provides nutrition for motility of sperm
Improvement in sperm count and motility
Helps in production of sex hormones
Prevents sperm damage
Altern Med Rev. 2000;5(1):28-38.

8. L-carnitine
Improves sperm motility
by providing energy to
the sperm cell through
fatty acid metabolism
Zinc
Promotes sperm production
& maturation testosterone
synthesis & improves sperm
morphology
Ideal Nutraceutical for Male Infertility
Coenzyme Q10
Improves sperm motility by
providing energy through
ATP generation in
mitochondrion
Lycopene
Increases sperm count and
improves morphology by
reducing oxidative damage
to sperm DNA and lipids

9. Female Infertility
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10.  Many studies have shown that micronutrient
supplements users have higher pregnancy rates
even if they have fertility disorders.
 It has been suggested that oxidative stress
plays a role in the pathophysiology of unexplained
infertility, endometriosis, polycystic ovarian
syndrome (PCOS), and tubal and peritoneal factor
infertility .
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11.  Moreover , there is some evidence of micronutrients role
in ovarian hormones secretion and uterus structure .
 Micronutrients useful in female infertility :
Iron
Folic acid
Vit. B Complex,
Carnitine
Vitamins A, D, E, C
Selenium , Arginine
Magnesium & Zinc
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12. Role
 Magnesium and Selenium supplementation resulted
in increased levels of RBC-Mg and serum glutathione
peroxidase and hence, improved fertility rates .
 Vitamin E supplement associated with increase
endometrial thickness .
 Total iron intake and intake of non-heme iron as well
as multivitamin consumption are associated with
lower risk of ovulatory infertility.
 Furthermore, sufficient levels of vitamin D as well as
folic acid supplement had resulted in increased
clinical pregnancy rate.
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13. L - Carnitine
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14. Carnitine
Trimethylated aminoacid -ester
Synthesized in liver, brain, and kidney from
dietary amino acids-methylation of lysine .
Most derived from diet: red meat, fish and
dairy products
L-carnitine is concentrated in high energy
demanding tissues such as skeletal and cardiac
muscles and in a specialized reproductive tract
organ.
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15. L-carnitine is biologically important
for mitochondrial beta-oxidation of
long-chain fatty acids and thus for
energy generation in the form of ATP.
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16. Pharmacokinetics
• Absorbed in the intestine by a combination of active
transport and passive dilution.
• Mucosal absorption is saturated at about a 2 g dose.
• Max blood concentrations are reached
approximately 3.5 hrs after an oral dose, with a half-
life of about 15 hrs.
• Stored in skeletal muscles, myocardium, epididymis,
liver and adrenal glands.
• Eliminated by kidneys
• Bioavailability varied 54-87%
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17. L – Carnitine in Male
Infertility
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18. Three compartments of the male genital
tract :
• Epididymal tissue,
• Seminal plasma, and
• Spermatozoa
maintain the highest free L-carnitine
concentrations in the body.
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19. The main function of L-Carnitine in the
epididymis is to provide an energetic
substrate for spermatozoa.
May be involved in the successful
maturation of sperm.
L-Carnitine is necessary for transport of fatty
acids into the mitochondria to produce
energy.
Low levels of L-Carnitine reduces fatty acid
concentrations within the mitochondria,
leading to decreased sperm motility
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20. • Significantly high levels of free L-Carnitine is
observed in the seminal plasma of the fertile men
compared to the infertile men.
• The level of free L-Carnitine in the semen has
positive correlation with sperm concentration, sperm
motility and vitality of sperm cells
• L-Carnitine provides readily available energy for
use by spermatozoa, which positively affects sperm
motility, maturation and the spermatogenesis process.
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Folia Med (Plovdiv). 2005;47(1):26–30.
. Zhonghua Nan Ke Xue. 2007;13(2):143–146.

21. L-Carnitine: Clinical Trials
According to a study conducted by Costa et al. L-carnitine
increased the sperm parameters drastically
10.8
28.4
3.73.1
142.4
18
32.5
4.1
20.3
163.3
0
20
40
60
80
100
120
140
160
180
Baseline At 4 months
Motile spermatozoa (%)
Mean velocity (microns)
Linearity index
Spermatozoa with rapid
linear progression (%)
Number of ejaculated
spermatozoa
Andrologia.1994;26:155-159.

22. L- Carnitine for asthenospermia with
varicocele
Carnitine
Placebo
Zhonghua Nan Ke Xue. 2004;10(9):671–672.
There was significant improvement in sperm count,motility
and pregnancy rates in infertility due to varicocele.

23. Use of Carnitine therapy in selected cases of male
factor infertility: A double-blind crossover trial
• Patient(s): One hundred infertile patients (ages
20–40 years) with the following baseline sperm
selection criteria: concentration, 10–20 X 106/mL;
total motility, 10%–30%; forward motility, <15%;
atypical forms, <70%; velocity, 10–30 µ/s;
• Interventions : L-Carnitine therapy 2 g/day or
placebo;
• Duration : 4 months
FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

24. Total motile sperm/mL
Carnitine
Placebo
FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

25. Forward motile sperm/mL
Carnitine
Placebo
FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

26. L- Carnitine in idiopathic asthenozoospermia:
a multicenter study.
Italian Study Group on Carnitine and Male
Infertility.
Andrologia 1994;26:155-159
 N = 100 patients
 L-carnitine - 3 g/day
 Duration - 4 months.
 Percentage of motile spermatozoa increased from 26.9
± 1.1 to 37.7 ± 1.1 %.
 Total number of spermatozoa per ejaculate also
increased
Conclusion - Oral administration of L-Carnitine
improves sperm quality

27. • Mazzilli et al, established strict correlation
between intrasperm L-carnitine content and sperm
motility survival in bovine cervical mucus. This is
possibly due to the fact that lipids are an important
energy source for sperm in cervical mucus and to
metabolize these lipids intrasperm Lcarnitine is
essential.
• L-carnitine not only helps in lipid metabolism but
also it modulates the reserves of free CoA, essential
for tricarboxylic acid ( TCA ) cycle regulation.
• Therefore, L carnitine content can be considered as
an indicator of sperm motility life span in cervical
mucus.
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28. Anti Oxidant Property
It is also proposed that carnitine
exerts antioxidant properties as a
result of repairing mechanism by
which elevated intracellular toxic
acetyl-CoA is removed and fatty acids
in membrane phospholipids are
replaced.
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29. Carnitine exerts its anti-apoptotic
effects in diverse tissues :
• Does carnitine exert anti-apoptotic
effects in the testis?
• Which step(s) of apoptosis does
carnitine influence?
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Anti-apoptotic effects

30. Carnitine in irradiated testes
• L- Carnitine enhanced the
recovery of spermatogonial cells
after X ray damage.
( AmendolaR et al. Andrologia. 1989 Nov.-Dec; (6):568-75. )
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31. Carnitine in heated testis
•More rapid recovery of
spermatogenesis after heat
treatment with L-ACAR
administration.
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32. L – Carnitine in
Female Infertility
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33.  Polycystic ovary syndrome (PCOS) is
often characterized by obesity and impaired
insulin function and affects about 7–10% of
women during reproductive age.
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34.  Obesity may play a role in the aetiology of PCOS,
and weight loss has been found to improve some
of the clinical aspects of PCOS including menses
regularity and fertility, as well as many
cardiovascular (CV) risk markers associated with
PCOS such as insulin resistance (IR) and
dyslipidaemia.
 IR affects approximately 65% of women
with PCOS and can potentially increase the
prevalence of impaired glucose tolerance, type 2
diabetes mellitus (T2DM) and metabolic
syndrome (MetS ).
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35. • L - Carnitine plays a substantial role
in weight loss, glucose tolerance,
insulin function and fatty acid
metabolism.
• The potential mechanisms include increasing
mitochondrial efflux of excess acyl groups
from insulin responsive tissues and facilitating
transportation of the long chain free fatty
acids into the mitochondrial matrix.
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36. • Some studies have reported that circulating
levels of free and total L carnitine were
significantly lower in PCOS women.
• In addition, in a study by Ismail et al….
Combined L – carnitine and clomiphene citrate
significantly improved both ovulation and
cumulative pregnancy rates in patients with
clomiphene resistant PCOS.
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37. Intravenous L - Carnitine (4 g/day)
among patients with MetS for 7
days resulted in weight loss,
improved fasting induced hunger
and cholesterol abnormalities.
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38. It’s proven that…
12 weeks of L - Carnitine
administration among women
diagnosed with PCOS had beneficial
effects on weight, BMI, Waist Circum,
Hip Circum. and glycemic control;
however, it does not affect lipid
profiles or free testosterone.
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39. Thank you