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Abbreviations ALC Acetyl L-Carnitine ART Assisted reproductive technology BCB Brilliant cresyl blue CoA Coenzyme-A COC Cumulus-oocyte complex CPT Cartinitine palmitoyltransferase DHEA Dehydroepiandrosterone eCG Equine chorionic gonadotropin ER Endoplasmic reticulum FHA Functional hypothalamic amenorrhea FISH Fluorescent in situ hybridization GABA -amino butyric acid GnRH Gonadotropin releasing hormone HPG Hypothalamo-pituitary gonadal axis IFN Interferon IVF In vitro fertilization LC L-carnitine LDL Low density lipoprotein LH Luteinizing hormone MII Metaphase-II NO Nitric oxide OCTN Organic cation transporter OS Oxidative stress PCOS Polycystic ovarian syndrome PG Prostaglandin PLC Propionyl L-carnitine PMSG Pregnant mares serum gonadotropin ROS Reactive oxygen species SCC Somatic cell count TNF Tumor necrosis factor Authors contributions PS (writing and revising the manuscript), DD (writing and revising the manuscript), AA (revising the manuscript)

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Additionally, these first-line agents on average cost anywhere from $29.43 to $844.87 monthly, with the majority of medication costs in the upper ranges (Table 1)