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Early Pregnancy Factor (EPF) is one of the earliest pregnancy associated signals, communicating the ensuing pregnancy to the maternal organism. Data published by others on the mouse suggest that EPF bound to spleen cells causes the release of two H2-restricted "suppressor factors" responsible for the rosette inhibiting activity of EPF in the rosette inhibition test. Using human material, we were able to detect the release of a second entity from mononuclear cells that is able to suppress rosette formation in the human rosette inhibition test. In an attempt to show an intracellular EPF effect in the target cell, cytosolic free calcium concentrations were measured in EPF-treated mononuclear cells from peripheral blood. Our findings did not, however, show any changes of intracellular free Ca(2+)-concentrations under the chosen conditions.

The authors validated use of the rosette inhibition test for the detection of early pregnancy factor (EPF) in human pregnancy, first by optimizing conditions for the assay, using known pregnant and nonpregnant sera, and second, by examining the performance of this assay in three clinical situations: a "blind" study involving coded first-trimester sera showed 80% correlation with pregnancy status; serial assay of EPF activity in sera collected from normal women attempting to conceive, correlated with human chorionic gonadotropin beta-subunit (beta-hCG) levels and pregnancy status; a longitudinal study of serial serum samples through two normal pregnancies showing the continued presence of EPF until the early third trimester in each case. It was concluded that with the rosette inhibition assay, consistent demonstration of a pregnancy-associated substance (EPF) could be obtained.

The rosette inhibition test was used to monitor the activity of an early pregnancy factor (EPF) in sera collected from 18 healthy women who were attempting to conceive. Serial blood samples collected during the luteal phase of 21 menstrual cycles demonstrated the appearance of EPF in 14 of the cycles, of which six showed only transient EPF activity over a 5-10 day period following ovulation. These results indicate a 67% rate of fertilization and a 36% rate of early conceptus losses.

Measurement of early pregnancy factor (EPF) by the rosette inhibition test was performed on serum samples from 14 women using intrauterine devices (IUDs). Serial blood samples taken during the luteal phase of 23 cycles demonstrated in six of the cycles a transient appearance of EPF during the 6- to 8-day period following ovulation. In contrast, no EPF activity was found in sera obtained from women in whom fertilization was prevented, either by sexual abstinence or tubal ligation. These observations support the postulate that the IUD functions by the prevention of implantation of the fertilized ovum, rather than by preventing fertilization.

An immunosuppressive early pregnancy factor associated with mammalian reproduction is currently attracting considerable interest. Research into its detection, site of production, distribution, immunosuppressive property, characterization, and application is in progress in a number of laboratories. This review aims to crystallize the current research findings and to identify significant areas for further investigation and application.