The Analysis of Infectious Chronic Endometritis (ALICE) is a test that helps evaluate pathogenic bacteria in a woman’s endometrial environment

A successful embryo implantation depends on the health of the endometrium (the lining of the womb). Pathogenic bacteria that can cause chronic endometritis are linked to implantation failure and recurrent miscarriages.

ALICE (Analysis of Infectious Chronic Endometritis) is a diagnostic test that detects pathogenic bacteria and can recommend appropriate probiotic or antibiotic treatment, and thereby improve their chances of conceiving.


ALICE tests require only a small endometrial tissue that can be taken at the clinic. It involves a small procedure, which requires no sedation. The sample will then be analysed using the latest Next Generation Sequencing (NGS) technology to provide a complete profile of the bacteria present in the tissue. EMMA includes the ALICE test that detects the bacteria causing chronic endometritis.

Who is the ALICE test recommended for?

ALICE test is beneficial for any patient looking to conceive, as it provides insights into the microbiological environment that the embryo will encounter during implantation. The test is also recommended to patients with repeated implantation failure or recurrent miscarriages to identify if chronic endometritis is an underlying condition and a cause for their fertility problems.

EMMA is an adjunct service and is not recommended for all patients. Please speak to your consultant about whether it might be beneficial for you.

Further Reading

Please refer to the regulator’s web page regarding treatment “add-ons” for further information: HFEA

Igenomix website: ALICE


Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature 2012; 486:207–14.

Moreno I, Codoñer FM, Vilella F, Valbuena D, Martinez-Blanch JF, Jimenez-Almazan J, Alonso R, Alama P, Remohi J, Pellicer A, Ramon D, Simon C. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016; 215:684-703.

Moreno I, Cicinelli E, Garcia-Grau I, Gonzalez M, Bau D, Vilella F, De Ziegler D, Resta L, Valbuena D, Simon C. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol. 2018, DOI: 10.1016/j.ajog.2018.02.012.