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However, the efficacy, stability, and safety of the agents, as well as whether they could disturb local or systemic energy metabolism should be considered comprehensively in future clinical uses

Authors' contributions Participated in research design: Ghayour, Abdolmaleki, Conducted experiments: Ghayour, Abdolmaleki, Behnam, Performed data analysis: Ghayour, Abdolmaleki, Wrote or contributed to the writing of the manuscript: Ghayour, Abdolmaleki, Behnam

Future research may explore whether the beneficial effects of L-Carnitine extend to protection against germ cell apoptosis and investigate the capacity of epididymal tissue for carnitine biosynthesis

Pooled treatment outcomes of Studies 104 and 111 through Week 144 are presented in Table 16