Flow Cytometry: A Novel Approach for Indirect Assessment of Protamine Deficiency by CMA3 Staining, Taking into Account the Presence of M540 or Apoptotic Bodies

Background: Chromomycin A3 (CMA3) staining, either by the slide method or fluorescence microscopy,is widely used for indirect assessment of protamine deficiency in a semen sample. Flow cytometry isthe most suitable tool to improve assessment accuracy, both in terms of statistical analysis and forprevention of observer variation. This study provides a simple procedure to account for merocyanine540 (M540) or apoptotic bodies, which result in underestimation of the percentage of CMA3 positivity,by using propidium iodide (PI) staining. Therefore, this study aims to evaluate the percentage of CMA3by PI staining to exclude M540 bodies that prevent underestimation of CMA3 staining. Materials and Methods: This study is an experimental study. Semen samples collected from 104 infertile men who referred to the Andrology Unit of the Isfahan Fertility and Infertility Center were initially assessed according to World Health Organization (WHO) criteria. Samples were washed twice with Ham’s. Each sample was divided into two portions, a control and the other processed for density gradient centrifugation (DGC). Each portion was assessed for CMA3 staining by both theslide and flow cytometry methods. Coefficients of correlation and student t-test were carried out using the Statistical Package for the Social Studies (SPSS 11.5). Results: Detection of CMA3 staining was more appropriate with fluorescence detector 3 (FL-3)rather than fluorescence detector 2 (FL-2) in the evaluation of protamine deficiency to excludeM540 bodies. Conclusion: This study, for the first time, provides the basis for assessment of CMA3 staining for flow cytometry. However, since the maximum excitation for CMA3 is not covered by the 488 nm laser, we recommend further experimentation using a flow cytometer with optimal excitation.