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Objective: The intercycle FSH signal that initiates follicular recruitment and marks the functional onset of the menstrual cycle is of small amplitude and while it commonly occurs on cycle day 3, this often varies. Hence, its identification and measurement in serum (sFSH) requires serial daily samplings. We attempted to determine whether urine measurements of FSH (uFSH) could offer a non-invasive alternative, using a model where the intercycle FSH signal is controlled by timely use of exogenous E2., Patients and Methods: Pilot prospective trial in 21 infertile women having received E2, from day 25 of the previous cycle until the 1st Friday after menses. Blood and first void urine samples were collected, starting on the last day of E2 (baseline) for assessing FSH and creatinin. A sonogram was performed for identification of maturing follicles (>12 mm)., Results: uFSH and uFSH/Cr showed good correlation with sFSH (R = 0.52 and 0.63, P < 0.0001 and P < 0.0001, respectively). In 15/21 patients who had an intercycle sFSH elevation, this was confirmed by uFSH elevation, both occurring within 2-4 days after stopping E2. In all these women, the sonogram showed evidence of impending ovulation. The amplitude of the uFSH signal was on average 3 times higher than its sFSH counterpart. In 6/21 women, no intercycle FSH elevation was detected and no ovulation occurred., Discussion and Conclusion: Our results show that the intercycle FSH signal can easily be identified and measured in urine. This novel approach permits more precise assessments of ovarian physiology than with blood measurements.

Objective: To evaluate the association between cervical oncofoetal fibronectin and prematurity as well as the interval between sampling and delivery in symptomatic women., Methods: Cervical fibronectin was measured with an immunoassay in a cohort of 64 women at the University Hospital of Geneva. Subjects with positive and negative fibronectin were then compared using the relative risk and the incidence rate ratio of premature delivery as well as the survival tables. Performance of the test to predict premature delivery or delivery within one week of the test were expressed in terms of sensitivity, specificity, predictive values and likelihood ratios with their 95% confidence intervals., Results: Thirty-four percent of women delivered prematurely. The presence of fibronectin was significantly associated with premature delivery and with a shorter interval to delivery. The likelihood ratio for a positive test was 2.6(95% CI: 1.45-4.66). A negative test had a 100% predictive value to exclude delivery within one week of the test., Conclusion: Oncofoetal fibronectin appears to be the best marker currently available to predict premature delivery. A randomized trial is needed to confirm its clinical usefulness.

The trophoblastic cells of the blastocyst and of the placenta express an invasive phenotype. These cells produce and secrete metalloproteinases which are capable of digesting the extracellular matrix and invade it. The different endometrial cells produce the same enzymes and favour thus the implantation process. Among the numerous endometrial factors that control trophoblastic invasion, the components of the extracellular matrix such as laminin and fibronectin, play an important role. These glycoproteins, control the proteolytic activity of the invading cells by binding to their receptors (integrins) expressed on the cell membrane. When these receptors are distributed in a non polarised way they don't bind their ligands and the cells secrete proteases and invade the endometrium. Conversely, when the receptors are clustered, they bind to their ligands and the cell's invasive behaviour and protease secretion is inhibited. The endometrial extracellular matrix is thus a potent regulator of trophoblast invasion.

Sperm antigenicity is demonstrated by the formation of sperm antibodies following vasectomy and by the possible occurrence of hypersensitivity reactions in women to seminal fluid. It may be that immunosuppressor factors in seminal plasma, as well as certain placental hormones, could explain the fact that sperm are not rejected immunologically in the female genital tract. The role of these different immune factors in male infertility and in the pathogenesis of AIDS is discussed.

Immune tolerance of the mother towards the fetus, which is like an allograft, may be explained partially by the presence of immunosupressor factors produced by the placenta. The maternal production of antibodies against trophoblastic antigens would seem equally necessary to prevent the fetus being rejected by cytotoxic maternal lymphocytes. Where there is marked histocompatibility between partners the protecting antibodies are absent and that gives rise to repeated abortions. This hypothesis is discussed as well as the rationale of treatments that are aimed at increasing maternal production of protective antibodies in cases of habitual abortion.

This review article summarizes our knowledge about three proteins associated to human pregnancy: placental protein 12 and 14 (PP12, PP14) and pregnancy-associated plasma protein-A (PAPP-A). These have in common their origin since all three seem to be produced by the pregnant endometrium (although not exclusively). Two of these proteins (PP12, PP14) have been described independently by many authors and are thus known, under many different names. For each protein their biochemical properties, their origin and regulation, their biological properties, as well as potential clinical applications, are discussed in detail. The clinical applications of PP12, PP14 and PAPP-A measurements are not only limited to uterine pathologies but also include cancer (tumour markers) and pregnancy (hydatidiform moles and extra-uterine pregnancies). This review is the first complete and comparative study of these three proteins, but many more questions are asked than solved. This is essentially due to the fact that human endometrial proteins is a rather new subject.