Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

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

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

  • Login to see the comments

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

  1. 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. 2. Introduction Many studies and researches have proved that there is a strong positive relationship between Micronutrients & fertility. 22-Aug-16 Dr Shashwat Jani 99099 44160. 2
  3. 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“…. 22-Aug-16 Dr Shashwat Jani 99099 44160. 3
  4. 4. 22-Aug-16 Dr Shashwat Jani 99099 44160. 4
  5. 5. Male Infertility 22-Aug-16 Dr Shashwat Jani 99099 44160. 5
  6. 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. 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. 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. 9. Female Infertility 22-Aug-16 Dr Shashwat Jani 99099 44160. 9
  10. 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 . 22-Aug-16 Dr Shashwat Jani 99099 44160. 10
  11. 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 22-Aug-16 Dr Shashwat Jani 99099 44160. 11
  12. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 12
  13. 13. L - Carnitine 22-Aug-16 Dr Shashwat Jani 99099 44160. 13
  14. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 14
  15. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 15
  16. 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% 22-Aug-16 Dr Shashwat Jani 99099 44160. 16
  17. 17. L – Carnitine in Male Infertility 22-Aug-16 Dr Shashwat Jani 99099 44160. 17
  18. 18. Three compartments of the male genital tract : • Epididymal tissue, • Seminal plasma, and • Spermatozoa maintain the highest free L-carnitine concentrations in the body. 22-Aug-16 Dr Shashwat Jani 99099 44160. 18
  19. 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 22-Aug-16 Dr Shashwat Jani 99099 44160. 19
  20. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 20 Folia Med (Plovdiv). 2005;47(1):26–30. . Zhonghua Nan Ke Xue. 2007;13(2):143–146.
  21. 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. 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. 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. 24. Total motile sperm/mL Carnitine Placebo FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003
  25. 25. Forward motile sperm/mL Carnitine Placebo FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003
  26. 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. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 27
  28. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 28
  29. 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? 22-Aug-16 Dr Shashwat Jani 99099 44160. 29 Anti-apoptotic effects
  30. 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. ) 22-Aug-16 Dr Shashwat Jani 99099 44160. 30
  31. 31. Carnitine in heated testis •More rapid recovery of spermatogenesis after heat treatment with L-ACAR administration. 22-Aug-16 Dr Shashwat Jani 99099 44160. 31
  32. 32. L – Carnitine in Female Infertility 22-Aug-16 Dr Shashwat Jani 99099 44160. 32
  33. 33.  Polycystic ovary syndrome (PCOS) is often characterized by obesity and impaired insulin function and affects about 7–10% of women during reproductive age. 22-Aug-16 Dr Shashwat Jani 99099 44160. 33
  34. 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 ). 22-Aug-16 Dr Shashwat Jani 99099 44160. 34
  35. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 35
  36. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 36
  37. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 37
  38. 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. 22-Aug-16 Dr Shashwat Jani 99099 44160. 38
  39. 39. Thank you

×