A set of EMMA and ALICE tests is designed for patients experiencing recurrent implantation failures following in vitro fertilization procedures.

A common underlying cause is a latent, i.e. showing no clinical symptoms, chronic inflammation of the endometrium. The EMMA test identifies imbalances in the microbiome, while the ALICE test pinpoints the specific bacteria responsible for the inflammatory condition. A one-time endometrial biopsy is required for both tests, which significantly accelerates introduction of the appropriate treatment and preparation of the patient for another in vitro procedure.

In cases where the patient shows symptoms of endometrial inflammation, such as discharge or abdominal pain, only the ALICE test is conducted. This test identifies the specific bacteria responsible for this condition, which allows for the implementation of treatment with targeted antibiotics.

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EMMA I ALICE

EMMA Test

EMMA stands for ENDOMETRIAL MICROBIOME METAGENOMIC ANALYSIS, i.e. a molecular test that evaluates the so-called microbiome, i.e. the general profile of bacteria present in the endometrium. It provides insights into whether the uterus is adequately prepared for embryo implantation.

Molekularne testy bakteriologiczne endometrium

What is the role of bacteria in the uterus?

An appropriate balance of bacteria in the uterus is crucial as they establish a healthy microbiological environment – essential for successful embryo implantation.

Why should you perform the EMMA test?

The EMMA test determines whether there is an adequate amount of Lactobacillus (lactic acid bacteria) or whether there are too few of them and then it is necessary to implement therapy with appropriately selected probiotics. Consultation with a dietician may also be necessary here. Consultation with a dietician may also be necessary in such a case.

What is the EMMA test?

This method consists in detecting bacterial DNA through the so called next-generation sequencing, revealing various bacterial profiles associated with chances of successful pregnancy.

When is the EMMA test recommended?

The EMMA test is particularly recommended for women experiencing recurrent implantation failures, i.e. unsuccessful in vitro treatment.

When and how is the EMMA test performed?

Since the number of bacteria in the endometrium can vary over time and depends on various factors (hormone fluctuations, hygiene habits, general changes in health, sexual activity, etc.), an endometrial biopsy is required to perform the EMMA test. It has to be performed in the second phase of a natural cycle or a cycle induced with hormone replacement therapy. The patient is also required not to take standard antibiotics for three months prior to the biopsy.

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Molekularne testy bakteriologiczne endometrium

ALICE Test 

ALICE stands for ANALYSIS OF INFECTIOUS CHRONIC ENDOMETRITIS, a modern molecular test based on next-generation sequencing that identifies specific bacteria that may cause chronic inflammation of the endometrium.

Testy EMMA i ALICE

How does ALICE differ from the CD138 test?

In order to assess chronic endometrial inflammation (CE – chronic endometritis), we use the CD138 protein marker. It is a general test indicating possible endometrial infection by various microorganisms. We use the ALICE test when we want to know precisely which bacteria are causing CE.

How does the ALICE test work?

The test detects the presence of specific pathogenic bacteria that can cause chronic inflammation of the uterine cavity: Escherichia, Klebsiella, Enterococcus, Chlamydia, Mycoplasma, Neisseria, Ureaplasma, Streptococcus, and Staphylococcus.

Why should you perform the ALICE test?

The advantage of this type of test over routine cultures is that it detects culturable bacteria as well as those that cannot be detected in the culture. The ALICE test results can be helpful in determining the most suitable antibiotics to eliminate disease-causing pathogens.

When and how is the ALICE test conducted?

Since the number of bacteria in the endometrium can change over time and is dependent on various factors (hormonal fluctuations, hygiene habits, general changes in health, sexual activity, etc.) an endometrial biopsy is required to perform the ALICE test. It should be performed in the second phase of a natural cycle or a cycle induced by hormone replacement therapy. The patient is also required not to take standard antibiotics for three months prior to the biopsy.

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Testy EMMA i ALICE
EMMA and ALICE tests are manufactured by the biotech company Igenomix from Spain, globally recognized for its pioneering work in reproductive genetics.

When are the EMMA and ALICE tests recommended?

For asymptomatic patients with embryo implantation failures history, it is recommended to go for both tests in order to enable detection of potential dysbiosis and the possible latent infection (without symptoms). In this context, there is a good justification for simultaneous performance of both EMMA and ALICE tests. In some cases, where patients show symptoms that might require treatment, like discharge, abdominal pain, or an unpleasant smell – a detailed examination of the entire microbiome using the EMMA test might not be necessary. Identifying the potentially pathogenic bacteria with the ALICE test may suffice.

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Testy EMMA i ALICE

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