Review Question - QID 108697

A 26-year-old G6P1050 woman presents for evaluation of infertility. She and her husband have been trying to have a child for the past 3 years. Over that time period, the patient has suffered 5 miscarriages. Her past medical history is significant for anemia, bipolar disorder, and a blood clot in her right lower extremity that occurred during her first pregnancy. The patient reports she has been feeling fatigued and has gained at least 10 pounds within the last 2 months. She often cries when she thinks about the miscarriages and has trouble falling asleep at night. She admits that while she quit smoking during the pregnancy of her 1st child, and 1 month after the birth she started smoking again. She currently smokes about 1 pack of cigarettes per day. A review of systems is also positive for diffuse joint discomfort. The patient's current medications include minocycline for acne and prenatal vitamins. A physical exam is unremarkable. Her temperature is 99°F (37.2°C), pulse is 72/min, blood pressure is 118/78 mmHg, respirations are 12/minute, and oxygen saturation is 98% on room air. Routine labs are drawn, as shown below:

Leukocyte count: 6,500/mm^3
Platelet count: 210,000/mm^3
Hemoglobin: 11.0 g/dL
Prothrombin time: 12 seconds
Activated partial thromboplastin time: 43 seconds
International normalized ratio: 1.1

Which of the following is most likely associated with the cause of this patient’s infertility?