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There is widespread agreement that free radical damage is the primary driver of declining sperm quality.[] Researchers have found that CYP decreases the activity of antioxidative enzymes such as catalase (CAT) and glutathione peroxidase (GPx) while simultaneously elevating the amount of malondialdehyde (MDA).[] In addition, the lipophilic nature of CYP allows it to bioaccumulate in membranes, resulting in the production of reactive oxygen species that have a detrimental effect on the structure of transport proteins.[ , , ] L-carnitine (LC) is an amino acid which is reported to have antioxidant properties.[ , ] Significant amounts of the LC are detectable in the epididymis, where it is indispensable for spermatogenesis, sperm maturation, and metabolism.[] Due to its antioxidant properties, LC has a protective effect against the toxicity of various reprotoxic compounds.[] Oral administration of LC increases sperm motility in men whose sperm have normal glutathione peroxidase phospholipid hydroperoxide levels.[] One limitation of the therapeutic use of LC is its lower oral bioavailability, which is attributed to its higher hydrophilicity, which prevents it from freely diffusing through the lipid membrane of the intestine epithelial cells.[] Thus, one strategy to overcome this obstacle is to use a nanoparticle approach to deliver this compound to increase its bioavailability and cellular uptake

For example, granulosa cells transport glycolytic metabolites, such as pyruvate, to oocytes, where they are further metabolized into ATP within mitochondria [47, 48]

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IGT, impaired glucose tolerance

Critically, subgroup analyses comparing subcutaneous vs