Journal Article

Correlation of CMA3 Staining with Sperm Quality and Protamine Deficiency

Mahdi Zandemami, Durdi Qujeq, Mohammad Mehdi Akhondi, Kourosh Kamali, Mozhgan Raygani, Niknam Lakpour, Elham Savadi Shiraz and Mohammad Reza Sadeghi

in Laboratory Medicine

Published on behalf of American Society for Clinical Pathology

Volume 43, issue 6, pages 262-267
Published in print November 2012 | ISSN: 0007-5027
Published online September 2015 | e-ISSN: 1943-7730 | DOI:
Correlation of CMA3 Staining with Sperm Quality and Protamine Deficiency

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  • Haematology
  • Medical Microbiology and Virology
  • Microbiology


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Protamines cause sperm chromatin to compact and its deficiency is associated with poor fertilizing ability and low quality of spermatozoa. However, the threshold for deficiency has not been well established. The aim of this study was to determine the threshold of sperm protamine content that correlates with diminished sperm quality.


Semen samples were obtained from 238 idiopathic oligoasthenoteratozoospermic (OAT) and 208 normospermic men. Semen was analyzed according to WHO guidelines. Sperm protamine content was assessed by chromomycin A3 (CMA3) staining.


The mean level of CMA3 staining was significantly higher in OAT than in men with normal sperm (P<0.001). CMA3 staining correlated negatively with sperm concentration (r=-0.338, P<0.001), motility (r=-0.273, P<0.001), and normal morphology (r=-0.303, P<0.001). Using ROC analysis we showed that 31% of stained sperm represents an appropriate cut-off point for protein deficiency (men with higher than 31% stained sperm are protamine deficient).


High odds ratio of OAT men followed by ROC analysis with a cut-off point of 31% for CMA3 staining revealed that this test is a sensitive and specific for evaluating of protamination, maturity, and quality of spermatozoa.

Keywords: CMA3; cut-off; male infertility; oligoasthenoteratozoospermia; protamine deficiency; semen parameters

Journal Article.  3026 words.  Illustrated.

Subjects: Haematology ; Medical Microbiology and Virology ; Microbiology

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