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The mechanism of carnitines effect is not fully understood, but it might relate to its impact on epididymal conditions, reducing gamete phagocytosis and increasing sperm count

Also noteworthy is the difference from another condition called Gilbert syndrome, where mostly unprocessed bilirubin accumulates, unlike Rotor syndrome where its primarily processed bilirubin present in high amounts

doi: 10.3389/fmicb.2025.1577724 66