Bozhedomov V A, Lipatova N A, Bozhedomova G E, Rokhlikov I M, Shcherbakova E V, Komarina R A
Polyclinic 3 of the ADP of the RF, 2N.A. Semashko Railroad Hospital, 3I.M. Sechenov First MSMU, 4City Polyclinic 68, Moscow Health Department, Moscow, Russia.
Urologiia. 2017 Jul(3):22-32. doi: 10.18565/urol.2017.3.22-32.
The most common cause of male infertility is idiopathic oligo-, and or astheno-, and /or teratozoospermia. In such cases, anti-estrogens, antioxidants (vitamins and trace elements) or carnitines are used, but the evidence on their effectiveness is inconsistent; there are currently no published studies exploring their concurrent use.
To investigate the efficacy and safety of the L- and acetyl-L-carnitine complex, vitamins A, E, C, selenium, zinc and other antioxidants ("SpermActin" + "More than vitamins") in combination with clomiphene citrate (CC) in managing male idiopathic infertility in the form of oligo, and/or astheno-, and/or teratozoospermia.
The study comprised 173 men from infertile couples aged 25-45 years who were divided into two groups - the study group (n=88) and control group (n=85). All the patients were examined according to the WHO recommendations. Patients of the study group received L-carnitine fumarate (1 g), acetyl-L-carnitine (0.5 g) twice daily, a complex of vitamins and microelements and CC 25 mg twice daily orally. Patients of the control group were administered the same dosages of CC and a complex of vitamins. Ejaculate was evaluated before and after 3-4 months of treatment. Six months after the start of treatment, information about the onset or absence of pregnancy over the last six months was collected via telephone or online survey.
Co-administration of L- and acetyl-L-carnitines concurrently with CC and antioxidant complex (vitamins and minerals) in patients with idiopathic oligo- and/or asteno- and/or teratozoospermia provides some additional positive effect on the concentration of spermatozoa, more pronounced in patients with multiple impaired semen parameters - oligoasthenoteratozoospermia, but does not improve the morphology, progressive sperm motility and pregnancy rates compared to patients receiving basic treatment.
男性不育最常见的原因是特发性少精子症、弱精子症和/或畸形精子症。在这种情况下，会使用抗雌激素、抗氧化剂（维生素和微量元素）或肉碱，但关于它们有效性的证据并不一致；目前尚无已发表的研究探讨它们的联合使用情况。
研究左旋肉碱和乙酰左旋肉碱复合物、维生素A、E、C、硒、锌及其他抗氧化剂（“精子活力素”+“不止是维生素”）与枸橼酸氯米芬（CC）联合使用治疗男性特发性少精子症、弱精子症和/或畸形精子症不育的疗效和安全性。
该研究纳入了173名年龄在25 - 45岁的不育夫妇中的男性，分为两组——研究组（n = 88）和对照组（n = 85）。所有患者均按照世界卫生组织的建议进行检查。研究组患者每日两次口服富马酸左旋肉碱（1克）、乙酰左旋肉碱（0.5克）、维生素和微量元素复合物以及25毫克CC。对照组患者给予相同剂量的CC和维生素复合物。在治疗3 - 4个月前后对精液进行评估。治疗开始6个月后，通过电话或在线调查收集过去6个月内是否怀孕的信息。
对于特发性少精子症、弱精子症和/或畸形精子症患者，左旋肉碱和乙酰左旋肉碱与CC及抗氧化剂复合物（维生素和矿物质）联合使用对精子浓度有一定额外的积极作用，在精液参数多项受损的少弱畸精子症患者中更为明显，但与接受基础治疗的患者相比，并未改善精子形态、精子前向运动能力和妊娠率。
