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Its possible you may be suffering from a genetic condition, abnormal testosterone levels, or an anatomic issue like a varicocele, which occurs when the blood vessels around the testicle are dilated, causing temperature increases that disrupt sperm production

Interestingly, there was no difference in carnitine levels between MS patients with or without fatigue

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Prostaglandins Leukot Essent Fatty Acids 67:3338 Torrioli MG, Vernacotola S, Peruzzi L, Tabolacci E, Mila M, Militerni R, Musumeci S, Ramos FJ, Frontera M, Sorge G, Marzullo E, Romeo G, Vallee L, Veneselli E, Cocchi E, Garbarino E, Moscato U, Chiurazzi P, DIddio S, Calvani M, Neri G (2008) A double-blind, parallel, multicenter comparison of L-acetylcarnitine with placebo on the attention deficit hyperactivity disorder in fragile X syndrome boys