title: Failed fertilization after ICSI and spermiogenic defects.
abstract: OBJECTIVE
  To evaluate the relationship between late spermiogenic events, including histone-protamine replacement, acrosome integrity, and sperm morphology, with fertilization rate after intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Isfahan Fertility and Infertility Center, Royan Institute, Tehran, Iran.
  
  
  METHODS
  Semen samples from 68 infertile couples undergoing ICSI at Isfahan Fertility and Infertility center were assessed during this study.
  
  
  METHODS
  Semen analysis was carried out according to World Health Organization criteria. Protamine deficiency, acrosin activity, sperm morphology, and acrosome size were assessed by chromomycin A3 (CMA3) staining, gelatinolysis test, and Papanicolaou staining (strict criteria), respectively.
  
  
  METHODS
  The correlation between protamine deficiency, sperm morphology, acrosin activity, and acrosome size with each other and fertilization rate were assessed.
  
  
  RESULTS
  Percentage CMA3 positivity and mean halo diameter show a significant correlation with fertilization rate. However, no correlation was found between sperm normal morphology and fertilization rate. The mean values of acrosome size and fertilization rate were significantly different when patients were grouped for CMA3 positivity of 40%. Multiple linear regression analysis revealed that only protamine deficiency has direct effect on fertilization rate.
  
  
  CONCLUSIONS
  Protamine deficiency appears to have a more significant effect on fertilization after ICSI than acrosin activity and semen parameters.
authors.affiliation: Department of Embryology and Andrology, Royan Institute, Tehran, Iran. mh_nasr@med.mui.ac.ir
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Nasr-Esfahani
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Razavi
authors.forename: Marzeyeh
authors.initials: M
authors.lastname: Tavalaee
mesh_terms: D000176:Acrosin / Q000032:analysis; D000177:Acrosome / Q000473:pathology; D000328:Adult; D048430:Cell Shape; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007248:Infertility, Male / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D011479:Protamines / Q000032:analysis; D012661:Semen / Q000737:chemistry / Q000166:cytology; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa / Q000737:chemistry / Q000473:pathology; D017211:Treatment Failure
chemical_list: D011479:Protamines; D000176:Acrosin