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The higher the number of abnormal sperm cells, the lower the chances of fertilisation, which is why a supplement like L-carnitine can make a real difference

Sterne JA, Hernn MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Interestingly, the administration of SP, L-car, and their combination was able to reverse the changes in hormonal levels as presented in the DOX + SP, DOX + L-car, and DOX+(SP + L-car) groups, especially the DOX+(SP + L-car), unlike the DOX group, reflecting their protective role against ovarian toxicity induced by DOX

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If the medication causes fatigue and the resulting caloric restriction depletes B12, then providing supplemental B12 directly in the injection could mitigate both problems simultaneously