Context: Epididymis is highly rich by L-carnitine (LC), which serves as a protectant agent for the oxidation process and also has key roles in energy production and motility enhancement. Progress in cancer survivor beside dramatic increase in cancer prevalence has led to universal interest for fertility preservation in survival of patients with cancer. Recently, a trend is established for evaluating the effects of LC and its ester supplementation on radio and chemotherapy induced gonadal injury. This article focused on chemotherapy induced infertility, mechanisms involved, and the possible protective role of LC. Evidence Acquisition: All papers including clinical trials, case reports, case series, and reviews on the role of LC in the cancer induced infertility were obtained by searching in medical publications such as Elsevier, PubMed, Google Scholar, and clinical trials. Results: L-carnitine pre-treatment was effective in improving sperm parameters, especially total motility, viability, reducing cell apoptosis; it was also able to promote the quality of the semen exacerbated by chemotherapy agents such as etoposide, doxorubicin, and cyclophosphamide in animal model. Conclusions: According to animal studies, the administration of LC could show a promising protective data, but before any judgment, further large controlled studies are required and issue is matter of concern in future studies.