Expert Add-on: Reproductive Thrombophilia & Implantation Coagulation Risk Panel (Quest)

What this panel includes

This panel should be paired with the full Women’s Fertility Expert Panel and adds markers focused on genetic thrombophilia, anticoagulant activity, and thrombotic risk.

Expert hormonal and metabolic assessment

• Reproductive and ovarian health: Estradiol, progesterone, total testosterone, free testosterone, DHEA S, FSH, LH, SHBG, prolactin, and Anti Müllerian hormone (AMH). Evaluates ovulation, ovarian reserve, androgen balance, hormone availability, and brain to ovary signaling.

• Thyroid function and immune regulation: TSH, free T4, free T3, TPO antibodies, thyroglobulin antibodies, and ANA panel. Assesses thyroid performance and screens for autoimmune patterns that may influence hormonal balance, metabolism, and fertility.

• Metabolic and cardiometabolic health: Comprehensive Metabolic Panel, fasting glucose, fasting insulin, hemoglobin A1c, leptin, lipid panel with ratios, lipoprotein(a), high sensitivity CRP, uric acid, and homocysteine. Provides insight into insulin sensitivity, metabolic regulation, inflammation, and cardiovascular risk factors that intersect with hormonal health.

• Blood health and systemic function: CBC with differential. Evaluates red and white blood cells and overall hematologic status.

• Nutrient and micronutrient status: Vitamin D, vitamin B12, folate, iron with TIBC, ferritin, magnesium (RBC), zinc, and selenium. Assesses nutrient levels essential for hormone production, thyroid conversion, ovulation, immune balance, and energy metabolism.

Additional markers for reproductive thrombophilia and coagulation risk

• Factor V Leiden mutation: The most common inherited thrombophilia variant, associated with increased clotting risk and placental thrombosis.

• Prothrombin gene mutation (Factor II G20210A): A hereditary thrombophilia variant associated with elevated thrombotic risk and pregnancy complications.

• PAI 1 (plasminogen activator inhibitor) 4G/5G genotype: A fibrinolysis regulator that influences clot breakdown and may affect implantation site vascular balance.

• Lipoprotein(a) [Lp(a)]: A genetically influenced cardiovascular risk marker associated with prothrombotic signaling and impaired fibrinolysis.

• Protein C activity: A natural anticoagulant protein that helps regulate clot formation; deficiency increases thrombotic risk.

• Protein S activity: A cofactor for protein C that supports anticoagulant activity and may be suppressed by estrogen exposure.

• Antithrombin III activity: A key inhibitor of thrombin and other clotting factors; deficiency alters coagulation balance and may affect anticoagulation management.

Together, these markers provide a comprehensive view of inherited thrombophilia, coagulation regulation, and thrombotic risk pathways that may influence implantation and pregnancy outcomes.

Biomarkers tested

Why patients choose this

• A deeper draw that adds targeted markers for inherited thrombophilia, anticoagulant activity, and thrombotic risk on top of the Women's Fertility Expert Panel.
• Provides deeper insight into coagulation patterns that may affect implantation and early pregnancy development.
• Evaluates genetic thrombophilia variants, natural anticoagulant protein activity, and cardiovascular thrombotic risk together.
• Especially useful for women with recurrent pregnancy loss, recurrent implantation failure, a history of placental complications, or clinical suspicion of underlying thrombophilia.
• Schedule your lab test seamlessly and complete it at a lab near you.

Before your test

This panel should be paired with the full Women's Fertility Expert Panel.

Cycle timing matters more for this panel than most. It is recommended that you schedule your lab draw on day 2 or 3 of a standard 28-day cycle.

Cycle timing is not always predictable. You may reschedule your lab appointment if needed, though same-week availability may be limited.

It is recommended to fast for at least 8 hours before your draw.

Important information

Why it matters: alterations in coagulation signaling or inherited thrombophilia variants can contribute to placental thrombosis, impaired implantation, placental insufficiency, and recurrent pregnancy loss, sometimes driven by genetic variants affecting clotting or fibrinolysis, and sometimes by altered levels of natural anticoagulant proteins.

Who it's for: especially useful for women with recurrent pregnancy loss, recurrent implantation failure, a history of placental complications, or clinical suspicion of underlying thrombophilia affecting reproductive health.

This panel should be paired with the full Women's Fertility Expert Panel.

It is recommended to fast for at least 8 hours before your draw.