Inflammatory, autoimmune & clotting tests

These are often sold together as a “recurrent loss panel.” Current guidance favours a stepwise workup driven by your history instead. Filia lists hs-CRP, homocysteine and a celiac panel; the antiphospholipid and thrombophilia testing below it does not sell.

hs-CRP: A dose-response association with pregnancy loss has been reported below the standard 3 mg/L flag — CRP 1–3 with RR 1.67, over 3–10 with RR 1.84, over 10 with RR 2.14. It is an association, not a treatment target: no guideline sets a fertility cutoff for hs-CRP, and lowering a number has not been shown to change loss rates. It is not recommended as routine fertility screening.

Antiphospholipid syndrome: When APS is diagnosed and treated, reported live-birth rates are high (roughly 80–90%). The catch is who should be tested: ASRM restricts testing to patients meeting clinical APS criteria, a positive result must be confirmed on repeat testing at least 12 weeks later, and management belongs with a specialist. Testing outside those criteria mostly produces false positives and unnecessary anticoagulation.

Inherited thrombophilia: Factor V Leiden and prothrombin G20210A have been associated with recurrent loss in some studies, but thrombophilia panels are not recommended for recurrent pregnancy loss without a specific indication such as a personal history of venous thrombosis. These are also genetic tests. Filia does not offer genetic testing at present: the methylation-pathway profile through Mosaic Diagnostics is not yet available to order, and thrombophilia panels are not in the catalog. Either way a result needs counselling about what it would and would not mean.

Celiac disease: Found in 5.9% of women with unexplained infertility versus about 1% of the general population. Tested with tTG-IgA plus total IgA, since IgA deficiency causes false negatives. This one is a reasonable clinician conversation.

Homocysteine: Rises with B-vitamin deficiency and has been associated with recurrent loss and preeclampsia, but testing homocysteine for recurrent pregnancy loss is specifically not recommended — it does not change management, and the “optimal 5–8 mcmol/L” figure is not a guideline target.