Objective:  Idiopathic  oligoathenoteratozoospermia (iOAT) is a common  finding  in male infertility  evaluation.  Oxidative  stress (OS) may underlie its pathology. Tamoxifen and L-carnitine are used to treat idiopathic male infertility. Aim of this work is to detect the efficacy of tamoxifen and L-carnitine on sperm parameters,  sperm ultrastructure and seminal OS in iOAT patients.

Material and Methods:  60 patients  were recruited  in this study and divided into three groups, the 1st  was treated with tamoxifen, 2nd with l-carnitine,   3rd  with  both   drugs.  Semen  analysis,  malondialdehye (MDA) level and transmission  electron  microscopy (TEM)  have been performed  before and after three  months  treatment.

Results:  The  first  group  showed  significant  improvement in MDA levels, sperm concentration, sperm morphology, ultrastructural head, acrosomal and mitochondrial anomalies (P < 0.01). Other  parameters

were not significantly improved. In the 2nd group, significant improvement  in  MDA,  sperm  motility,  sperm  morphology, ultrastructural mitochondrial and tail anomalies were detected  (P < 0.01). No signifi- cant improvement in the other parameters.  3rd group showed improvement in  MDA,  all semen  parameters  and  all ultastructural anomalies (P < 0.01).

Conclusion:  Tamoxifenand L-carnitine  are  effective  in  improving seminal OS, semen parameters and sperm ultrastructure. Combination of both drugs is superior  to monotherapy.