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This biochemical rationale provides a strong theoretical basis for L-carnitine supplementation in PN (Figure 3)

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Treatment begins at 0.25 mg once weekly, increasing gradually over 16 weeks to the maintenance dose of 2.4 mg

Although this pregnancy rate is lower than with in vitro fertilization and intracytoplasmic sperm injection, intrauterine insemination is often recommended first when feasible due to its lower invasiveness and cost

Each approach has its own tradeoff profile in terms of delivery efficiency, immune response risk, and the ability to re-treat if needed