it has been found that the combination according to the present invention is more active than the combination of l - carnitine and acetyl l - carnitine mentioned above , in improving both sperm count and sperm motility in man . the l - carnitine , acetyl l - carnitine and propionyl l - carnitine can be in any form suitable for oral or parenteral administration in man . l - carnitine , acetyl l - carnitine and propionyl l - carnitine can be formulated together , as a mixture , or can be formulated separately ( packaged separately ), using known methods . l - carnitine , acetyl l - carnitine and propionyl l - carnitine can be administered to an individual either when formulated in a mixture or when formulated in separate packs . on the basis of various factors , such as the concentration of the active ingredients or the patient &# 39 ; s condition , the combination according to the present invention can be marketed as a health food supplement , a nutritional supplement , or as a therapeutic product on sale with or without the need for a medical prescription . according to the present invention , the molar ratio of l - carnitine to acetyl l - carnitine and propionyl l - carnitine or of one of their pharmaceutically acceptable salts ranges from 2 . 48 : 0 . 098 : 0 . 092 to 0 . 186 : 0 . 98 : 0 . 92 . the combination preparation according to the present invention , when in unit dosage form , contains from 4 . 0 g to 0 . 30 g of l - carnitine inner salt , from 0 . 20 to 2 . 0 g of acetyl l - carnitine inner salt and from 0 . 20 g to 2 . 0 g of propionyl l - carnitine inner salt , or an equimolar amount of one of their pharmaceutically acceptable salts . the preferred combination preparation , in unit dosage form , contains 2 g of l - carnitine inner salt , 1 g of acetyl l - carnitine inner salt and 0 . 5 g of propionyl l - carnitine inner salt , or an equimolar amount of one of their pharmaceutically acceptable salts . it has been found , however , that , although the daily dose of the above - mentioned active ingredients to be administered depends on the patients age , weight and condition , using professional experience it is generally advisable to administer , in a single dose or in multiple doses , from 0 . 3 to 4 . 0 g / day approx . of l - carnitine , from 0 . 20 to 2 . 0 g / day approx . of acetyl l - carnitine , and from 0 . 20 to 2 . 0 g / day approx . of propionyl l - carnitine , or an equimolar amount of one of their pharmaceutically acceptable salts . larger doses can be administered thanks to the extremely low toxicity of said active ingredients . reported here below is a clinical trial conducted in order to assess whether or not the combination according to the present invention improves sperm motility as compared to combined therapy with l - carnitine plus acetyl l - carnitine . inclusion criteria : young infertile males with astheno - zoospermia recognised as being the sole cause of infertility over the preceding period of at least two years ; the semen criteria that had to be fulfilled in at least two samples were : sperm concentration ( m / ml ) from 10 to 20 , motility (%)& gt ; 20 & lt ; 40 at 2 hours , rapid linear progression (%)& lt ; 20 at 2 hours . the patients were subjected to history taking , bilateral scrotal echo - colour doppler , physical examination , hormone assays ( free and total testosterone , fsh , ml , 17 beta oestradiol , progesterone , prolactin ), and a spermiogram ( who 1999 ). exclusion criteria : acute genital inflammation , sperm concentration & lt ; 5 , 000 , 000 / ml . all patients gave their informed consent for participation in this open trial . in all , the patients examined were 8 patients with varicocele ( 6 grade ii , 2 grade iii ), 12 patients with chronic inflammation of the sex glands , 12 patients with varicocele ( 8 grade ii , 4 grade iii )+ chronic inflammation of the sex glands , 25 with cryptogenetic oligoasthenospermia , 2 with hypogonadotropic hypogonadism , 1 with hyperprolactinaemia , 4 with a history of surgery ( unilateral cryptorchidia in 3 cases , bilateral in 1 case ) and 2 with bilateral testicular trauma . semen was obtained by masturbation after at least 4 days of sexual abstinence . semen samples were analysed within one hour of ejaculation for all parameters , using the standard methods recommended by the who ( 1987 ). sperm motility was studied using a computerised motility analyser on at least two samples . semen analysis and the motility assessment were carried out before treatment with the study compounds and after 4 months &# 39 ; treatment with the latter . l - carnitine was administered at the dose of 2 g / day ( 2 × 500 mg tablets twice daily , after lunch ) for 4 months ; acetyl l - carnitine was administered at the dose of 1 g / day for 4 months , while propionyl l - carnitine was administered at the dose of 500 mg / day for 4 months . the combination according to the present invention significantly increases the sperm concentration and motility as well as the percentage of spermatozoa with a rapid linear progression as compared to treatment with the l - carnitine plus acetyl l - carnitine combination , regardless of the cause of the oligoasthenoteratospermia , even in patients with hormonal abnormalities . in the latter , the combination according to the invention has permitted a reduction in the posology of gonadotropins and antiprolactinaemia drugs compared to the data reported in the literature . the medicine according to the invention described herein can be prepared by mixing the active ingredients ( l - carnitine inner salt , acetyl l - carnitine inner salt and propionyl l - carnitine inner salt or one of their pharmacologically acceptable salts ) with suitable excipients for the formulation of compositions for enteral ( particularly oral ) or parenteral ( particularly intramuscular of intravenous ) administration . experts in pharmaceutical technology are familiar with said excipients . the pharmaceutically acceptable salts of the above - mentioned active ingredients include all the pharmaceutically acceptable salts that are prepared by addition of an acid to the l - carnitine , acetyl l - carnitine and propionyl l - carnitine inner salt , and that do not give rise to unwanted toxic or side effects . the formation of salts by addition of an acid is well known in pharmaceutical technology . examples of such salts , though not exclusively these , are : chloride , bromide , orotate , aspartate , acid aspartate , citrate , acid citrate , magnesium citrate , phosphate , acid phosphate , fumarate , acid fumarate , magnesium fumarate , glycerophosphate , lactate , maleate and acid maleate , mucate , oxalate , acid oxalate , pamoate , acid pamoate , sulphate , acid sulphate , glucose phosphate , tartrate , acid tartrate , magnesium tartrate , 2 - amino ethane sulphonate , magnesium 2 - amino ethane sulphonate , methane sulphonate , choline tartrate , trichloroacetate and trifluoroacetate .
l - carnitine , acetyl l - carnitine and propionyl l - carnitine inner salts , or their pharmaceutically acceptable salts , are used in combination to treat oligoasthenoteratosperia including oligospermia , asthenospermia , and teratospermia .