{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:32:22Z","timestamp":1781584342257,"version":"3.54.5"},"reference-count":33,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T00:00:00Z","timestamp":1601596800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Varicocele has been found to impair the function of the epididymis resulting in subfertility whereas the varicocelectomy can resolve the phenomenon. L-carnitine is regarded as a biomarker for the function of the epididymis and has been found in reduced concentrations in infertile patients of various causes, including infertile men with varicocele. It seems that Lcarnitine and varicocele share clinical significance and the area of research looks promising. Objective: To identify the role of L-carnitine in the treatment of varicocele. Materials and methods: A systematic search was performed in Pubmed\/Medline with the terms (L-carnitine) and (varicocele) and (L-carnitine) and (varicocelectomy). Inclusion criteria were studies reported outcomes of L-carnitine administration alone or in duet, as primary or adjuvant treatment to varicocele. Exclusion criteria were non-English language and animal studies. Studies using L-carnitine as part of a panel of therapeutic agents were avoided. Results: Only four suitable studies were identified for discussion. In one randomized study, the combination of L-carnitine and cinnoxicam improved semen parameters in patients with non-high-grade varicocele compared to L-carnitine alone and had a favourable effect on pregnancy rates but the effect of grade is unknown. In another study, as an adjuvant treatment to varicocelectomy, L-carnitine showed no clear benefit. Finally, in comparison to surgery, the results are inconclusive; two studies showed some benefit might be expected in low-grade or subclinical varicocele, but surgery appears superior. Conclusions: The evidence regarding the role of L-carnitine as a primary or adjuvant treatment of varicocele is sparse. The pathophysiological significance of L-carnitine implicates a potential role of the molecule in the management of varicocele, but the evidence so far is controversial for any recommendations. L-carnitine might be taken into consideration in selected cases; however, further search is needed in order the optimal role of L-carnitine in infertile patients with varicocele to be clarified.<\/jats:p>","DOI":"10.4081\/aiua.2020.3.263","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T15:05:35Z","timestamp":1601651135000},"source":"Crossref","is-referenced-by-count":7,"title":["L-carnitine as primary or adjuvant treatment in infertile patients with varicocele. A systematic review"],"prefix":"10.4081","volume":"92","author":[{"given":"Georgios","family":"Tsampoukas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Faisal","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antigoni","family":"Katsouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waseem","family":"Akhter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Moussa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Deliveliotis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Papatsoris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Buchholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2020,10,2]]},"reference":[{"key":"28308","doi-asserted-by":"crossref","unstructured":"A. Agarwal, R. Sharma, A. Harlev, and S. Esteves, \u201cEffect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis,\u201d Asian J. Androl., vol. 18, no. 2, p. 163, 2016, doi: 10.4103\/1008-682X.172638.","DOI":"10.4103\/1008-682X.172638"},{"key":"28309","doi-asserted-by":"crossref","unstructured":"X. Wan, H. Wang, and Z. Ji, \u201cMicrosurgical varicocelectomy for clinical varicocele: A review for potential new indications.,\u201d Andrologia, vol. 49, no. 10, Dec. 2017, doi: 10.1111\/and.12827.","DOI":"10.1111\/and.12827"},{"key":"28310","unstructured":"N. Erfani Majd, N. Sadeghi, M. Tavalaee, M. R. Tabandeh, and M. H. Nasr-Esfahani, \u201cEvaluation of Oxidative Stress in Testis and Sperm of Rat Following Induced Varicocele.,\u201d Urol. J., vol. 16, no. 3, pp. 300\u2013306, Jun. 2019, doi: 10.22037\/uj.v0i0.4740."},{"key":"28311","doi-asserted-by":"crossref","unstructured":"K. Lorian et al., \u201cLong-term NaHS administration reduces oxidative stress and apoptosis in a rat model of left-side varicocele.,\u201d Andrologia, p. e13496, Dec. 2019, doi: 10.1111\/and.13496.","DOI":"10.1111\/and.13496"},{"key":"28312","doi-asserted-by":"crossref","unstructured":"M. I. Omar et al., \u201cBenefits of Empiric Nutritional and Medical Therapy for Semen Parameters and Pregnancy and Live Birth Rates in Couples with Idiopathic Infertility: A Systematic Review and Meta-analysis.,\u201d Eur. Urol., vol. 75, no. 4, pp. 615\u2013625, Apr. 2019, doi: 10.1016\/j.eururo.2018.12.022.","DOI":"10.1016\/j.eururo.2018.12.022"},{"key":"28313","doi-asserted-by":"crossref","unstructured":"E. A. Nada, M. A. El Taieb, H. M. Ibrahim, and A. E.-R. A. Al Saied, \u201cEfficacy of tamoxifen and l-carnitine on sperm ultrastructure and seminal oxidative stress in patients with idiopathic oligoasthenoteratozoospermia.,\u201d Andrologia, vol. 47, no. 7, pp. 801\u2013810, Sep. 2015, doi: 10.1111\/and.12333.","DOI":"10.1111\/and.12333"},{"key":"28314","doi-asserted-by":"crossref","unstructured":"A. Majzoub and A. Agarwal, \u201cSystematic review of antioxidant types and doses in male infertility: Benefits on semen parameters, advanced sperm function, assisted reproduction and live-birth rate.,\u201d Arab J. Urol., vol. 16, no. 1, pp. 113\u2013124, Mar. 2018, doi: 10.1016\/j.aju.2017.11.013.","DOI":"10.1016\/j.aju.2017.11.013"},{"key":"28315","doi-asserted-by":"crossref","unstructured":"L. Mongioi et al., \u201cThe role of carnitine in male infertility.,\u201d Andrology, vol. 4, no. 5, pp. 800\u2013807, Sep. 2016, doi: 10.1111\/andr.12191.","DOI":"10.1111\/andr.12191"},{"key":"28316","doi-asserted-by":"crossref","unstructured":"S. Banihani, A. Agarwal, R. Sharma, and M. Bayachou, \u201cCryoprotective effect of L-carnitine on motility, vitality and DNA oxidation of human spermatozoa.,\u201d Andrologia, vol. 46, no. 6, pp. 637\u2013641, Aug. 2014, doi: 10.1111\/and.12130.","DOI":"10.1111\/and.12130"},{"key":"28317","doi-asserted-by":"crossref","unstructured":"U. Wetterauer and H. J. Heite, \u201cCarnitine in seminal plasma: its significance in diagnostic andrology.,\u201d Arch. Androl., vol. 4, no. 2, pp. 137\u2013143, Mar. 1980, doi: 10.3109\/01485018008986480.","DOI":"10.3109\/01485018008986480"},{"key":"28318","doi-asserted-by":"crossref","unstructured":"L. M. Lewin, D. P. Shalev, R. Weissenberg, and Y. Soffer, \u201cCarnitine and acylcarnitines in semen from azoospermic patients.,\u201d Fertil. Steril., vol. 36, no. 2, pp. 214\u2013218, Aug. 1981.","DOI":"10.1016\/S0015-0282(16)45681-5"},{"key":"28319","doi-asserted-by":"crossref","unstructured":"M. De Rosa et al., \u201cCorrelation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins.,\u201d Drugs R. D., vol. 6, no. 1, pp. 1\u20139, 2005, doi: 10.2165\/00126839-200506010-00001.","DOI":"10.2165\/00126839-200506010-00001"},{"key":"28320","doi-asserted-by":"crossref","unstructured":"G. Cavallini, A. P. I. A. Ferraretti, L. Gianaroli, G. Biagiotti, and G. Vitali, \u201cCinnoxicam and L-carnitine\/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia,\u201d J. Androl., vol. 25, no. 5, pp. 761\u2013770, 2004, doi: 10.1002\/j.1939-4640.2004.tb02853.x.","DOI":"10.1002\/j.1939-4640.2004.tb02853.x"},{"key":"28321","unstructured":"H. Sofimajidpour, E. Ghaderi, and O. Ganji, \u201cComparison of the Effects of Varicocelectomy and Oral L-carnitine on Sperm Parameters in Infertile Men with Varicocele.,\u201d J. Clin. Diagn. Res., vol. 10, no. 4, pp. PC07-10, Apr. 2016, doi: 10.7860\/JCDR\/2016\/18464.7557."},{"key":"28322","doi-asserted-by":"crossref","unstructured":"J. T. Seo, K. T. Kim, M. H. Moon, and W. T. Kim, \u201cThe significance of microsurgical varicocelectomy in the treatment of subclinical varicocele,\u201d Fertil. Steril., vol. 93, no. 6, pp. 1907\u20131910, 2010, doi: 10.1016\/j.fertnstert.2008.12.118.","DOI":"10.1016\/j.fertnstert.2008.12.118"},{"key":"28323","doi-asserted-by":"crossref","unstructured":"G. Pourmand et al., \u201cDoes L-carnitine therapy add any extra benefit to standard inguinal varicocelectomy in terms of deoxyribonucleic acid damage or sperm quality factor indices: a randomized study.,\u201d Urology, vol. 84, no. 4, pp. 821\u2013825, Oct. 2014, doi: 10.1016\/j.urology.2014.07.006.","DOI":"10.1016\/j.urology.2014.07.006"},{"key":"28324","doi-asserted-by":"crossref","unstructured":"U. Wetterauer and H. J. Heite, \u201cCarnitine in seminal fluid as parameter for the epididymal function.,\u201d Andrologia, vol. 10, no. 3, pp. 203\u2013210, 1978, doi: 10.1111\/j.1439-0272.1978.tb03017.x.","DOI":"10.1111\/j.1439-0272.1978.tb03017.x"},{"key":"28325","doi-asserted-by":"crossref","unstructured":"S. D. Milingos, \u201cThe epididymal factor--a diagnostic approach.,\u201d Int. J. Androl., vol. 8, no. 6, pp. 417\u2013420, Dec. 1985, doi: 10.1111\/j.1365-2605.1985.tb00854.x.","DOI":"10.1111\/j.1365-2605.1985.tb00854.x"},{"key":"28326","unstructured":"A. Lenzi, F. Lombardo, L. Gandini, and F. Dondero, \u201c[Metabolism and action of L-carnitine: its possible role in sperm tail function].,\u201d Arch. Ital. Urol. Nefrol. Androl., vol. 64, no. 2, pp. 187\u2013196, Jun. 1992."},{"key":"28327","doi-asserted-by":"crossref","unstructured":"B. Gurbuz, S. Yalti, C. Ficicioglu, and K. Zehir, \u201cRelationship between semen quality and seminal plasma total carnitine in infertile men.,\u201d J. Obstet. Gynaecol., vol. 23, no. 6, pp. 653\u2013656, Nov. 2003, doi: 10.1080\/01443610310001604466.","DOI":"10.1080\/01443610310001604466"},{"key":"28328","unstructured":"I. Matalliotakis, Y. Koumantaki, A. Evageliou, G. Matalliotakis, A. Goumenou, and E. Koumantakis, \u201cL-carnitine levels in the seminal plasma of fertile and infertile men: correlation with sperm quality.,\u201d Int. J. Fertil. Womens. Med., vol. 45, no. 3, pp. 236\u2013240, 2000."},{"key":"28329","unstructured":"G. Vivas-Acevedo, R. Lozano-Hernandez, and M. I. Camejo, \u201cMarkers of accessory sex glands function in men with varicocele, relationship with seminal parameters.,\u201d Can. J. Urol., vol. 18, no. 5, pp. 5884\u20135889, Oct. 2011."},{"key":"28330","doi-asserted-by":"crossref","unstructured":"K. Zhang, Z. Wang, H. Wang, Q. Fu, H. Zhang, and Q. Cao, \u201cHypoxia-induced apoptosis and mechanism of epididymal dysfunction in rats with left-side varicocele.,\u201d Andrologia, vol. 48, no. 3, pp. 318\u2013324, Apr. 2016, doi: 10.1111\/and.12449.","DOI":"10.1111\/and.12449"},{"key":"28331","doi-asserted-by":"crossref","unstructured":"M. Lehtihet, S. Arver, B. Kalin, U. Kvist, and A. Pousette, \u201cLeft-sided grade 3 varicocele may affect the biological function of the epididymis.,\u201d Scand. J. Urol., vol. 48, no. 3, pp. 284\u2013289, Jun. 2014, doi: 10.3109\/21681805.2013.868513.","DOI":"10.3109\/21681805.2013.868513"},{"key":"28332","unstructured":"B. Pajovic, A. Dimitrovski, N. Radojevic, and M. Vukovic, \u201cA correlation between selenium and carnitine levels with hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients.,\u201d Eur. Rev. Med. Pharmacol. Sci., vol. 20, no. 4, pp. 598\u2013604, 2016."},{"key":"28333","doi-asserted-by":"crossref","unstructured":"R. Henkel, I. S. Sandhu, and A. Agarwal, \u201cThe excessive use of antioxidant therapy: A possible cause of male infertility?,\u201d Andrologia, vol. 51, no. 1, p. e13162, Feb. 2019, doi: 10.1111\/and.13162.","DOI":"10.1111\/and.13162"},{"key":"28334","doi-asserted-by":"crossref","unstructured":"A. Agarwal et al., \u201cMale Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility.,\u201d World J. Mens. Health, May 2019, doi: 10.5534\/wjmh.190055.","DOI":"10.5534\/wjmh.190055"},{"key":"28335","doi-asserted-by":"crossref","unstructured":"G. M. Busetto et al., \u201cEffect of metabolic and antioxidant supplementation on sperm parameters in oligo-astheno-teratozoospermia, with and without varicocele: A double-blind placebo-controlled study.,\u201d Andrologia, vol. 50, no. 3, Apr. 2018, doi: 10.1111\/and.12927.","DOI":"10.1111\/and.12927"},{"key":"28336","doi-asserted-by":"crossref","unstructured":"J. Gual-Frau et al., \u201cOral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients.,\u201d Hum. Fertil. (Camb)., vol. 18, no. 3, pp. 225\u2013229, Sep. 2015, doi: 10.3109\/14647273.2015.1050462.","DOI":"10.3109\/14647273.2015.1050462"},{"key":"28337","doi-asserted-by":"crossref","unstructured":"H. J. Kim et al., \u201cClinical significance of subclinical varicocelectomy in male infertility: systematic review and meta-analysis.,\u201d Andrologia, vol. 48, no. 6, pp. 654\u2013661, Aug. 2016, doi: 10.1111\/and.12495.","DOI":"10.1111\/and.12495"},{"key":"28338","doi-asserted-by":"crossref","unstructured":"A. Cyrus, A. Kabir, D. Goodarzi, and M. Moghimi, \u201cThe effect of adjuvant vitamin C after varicocele surgery on sperm quality and quantity in infertile men: a double blind placebo controlled clinical trial.,\u201d Int. Braz J Urol, vol. 41, no. 2, pp. 230\u2013238, 2015, doi: 10.1590\/S1677-5538.IBJU.2015.02.07.","DOI":"10.1590\/S1677-5538.IBJU.2015.02.07"},{"key":"28339","doi-asserted-by":"crossref","unstructured":"S. Akdemir et al., \u201cDifferent surgical techniques and L-carnitine supplementation in an experimental varicocele model.,\u201d Andrologia, vol. 46, no. 8, pp. 910\u2013916, Oct. 2014, doi: 10.1111\/and.12172.","DOI":"10.1111\/and.12172"},{"key":"28340","doi-asserted-by":"crossref","unstructured":"N. Thirumavalavan et al., \u201cThe Impact of Microsurgical Repair of Subclinical and Clinical Varicoceles on Total Motile Sperm Count: Is There a Difference?,\u201d Urology, no. 713, pp. 1\u20135, 2018, doi: 10.1016\/j.urology.2018.06.036.","DOI":"10.1016\/j.urology.2018.06.036"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/download\/aiua.2020.3.263\/9040","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/download\/aiua.2020.3.263\/9040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T17:07:54Z","timestamp":1613754474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/view\/aiua.2020.3.263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,2]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,10,2]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2020.3.263","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"value":"2282-4197","type":"electronic"},{"value":"1124-3562","type":"print"}],"subject":[],"published":{"date-parts":[[2020,10,2]]}}}