Effects of treatment with carnitines in infertile patients with prostato-vesiculo-epididymitis

BACKGROUND: We have recently shown that patients with prostato-vesiculo-epi didymitis (PVE) have a greater reactive oxygen species (ROS) overproduction than patients with prostatitis or prostato-vesiculitis. Since this biochem ical stress persists even after treatment with antimicrobials, it may relat e to an imbalance between pro-and anti-oxidant factors at the epididymal le vel. METHODS: To evaluate the effects of antioxidant treatment of patients with PVE, whether in the presence or absence of pro-oxidant factors, abacte rial PVE infertile patients with normal (<1 X 10(6)/ml, group A, n = 34) or abnormal (>1 X 10(6)/ml, group B, n = 20) seminal white blood cell (WBC) c oncentrations received carnitines (L-carnitine 1 g and acetyl-carnitine 0.5 g twice/day) for 3 months followed by a wash-out period of 3 months. Semen parameters, ROS production and pregnancy outcome were evaluated before, du ring and following carnitine treatment. RESULTS: Carnitines increased sperm forward motility and viability in group A patients. This was associated wi th a significant reduction in ROS production which persisted during wash-ou t. Carnitines increased only the percentage of viable spermatozoa in group B patients. Within 3 months after the discontinuation of carnitines, the ra te of spontaneous pregnancy in group A patients was significantly higher th an that of group B patients, being 11.7% (4/34) compared with 0%. CONCLUSIO N: These results indicate that carnitines are only an effective treatment i n patients with abacterial PVE and elevated ROS production when seminal WBC concentration is normal.