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Genetic Solutions > ALICE

ALICE Analysis of Infectious Chronic Endometritis

ALICE detects the bacteria causing chronic endometritis to improve your patient’s reproductive
prognosis

  • Technical Overview
  • Documentation
  • Scientific evidence
  • I’m not a health specialist

20% of infertility is caused by the endometrial factor.

Chronic endometritis affects up to 30% of infertile patients.

+20 years’ experience
in genetics

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Overview
  • ALICE
  • Indications
  • Benefits

What is ALICE test?

ALICE is a test that detects pathogenic bacteria and recommends adequate treatment.

Pathogenic bacteria cause chronic endometritis, which is linked to implantation failure and recurrent miscarriage.

In cases of repeated implantation failure or recurrent pregnancy loss, chronic endometritis can rise to 66%.

Methodology

endometritis

ALICE can be performed on a small piece of an endometrial biopsy.

If the patient is undergoing an ERA test, a small portion of the same biopsy can be used, so no additional sample will be required.

How to collect and send the sample

For EMMA, an endometrial biopsy should be taken from day 15 to day 25 of the menstrual cycle. After retrieval, it is important that the sample is briefly shaken vigorously and immediately placed in the refrigerator at 4–8°C for a minimum of 4 hours.

Who should use ALICE?

  • ALICE can be beneficial for any patient wishing to conceive, by assessing the microbiological environment that the embryo will encounter at implantation.
  • ALICE may also be beneficial for patients with a history of recurrent pregnancy loss or recurrent implantation failure because chronic endometritis has been linked to these events.

Test limitations

  • Any planned uterine surgical intervention should be performed before sample collection, so that the endometrium is in suitable condition for embryo transfer
  • Some reports describe a higher prevalence of microbiota alterations in patients with endometriosis
  • If the patient has fluid in the endometrial lining, the biopsy can be taken. This liquid is most likely caused by an infection of the endometrium
  • The biopsy could be performed even if the endometrium does not have a trilaminar appearance
  • If a Dilation and Curettage takes place after EMMA or ALICE test, the results could change. We recommend repeating the test after D&C procedures, ideally in the cycle immediately before the embryo transfer.
  • We currently have no data about the effect of chemotherapy or radiation on the endometrial microbiome
  • We currently have no data about the relationship between chronic thyroiditis or polycystic ovary syndrome and the abnormal microbiota
  • Use of antibiotics can affect EMMA results and should be disclosed when requesting the test
    • Inadequate sample or sample preservation:
    • Sample not stored at 4–8°C for a minimum of 4 hours.
    • Degradation of sample due to displacement of RNAlater stabilization solution from the cryotube by a biopsy that is very large or not fully immersed in preserving agent.
    • Insufficient starting material: Not enough tissue sample. (7mm tissue is optimal)
    • Excessive blood and mucus in the biopsy sample
    • External or residual contamination
    • Exposure to excessively high temperatures

Clinical Limitations:

  • These tests are not able to detect resistance to antibiotics
    ALICE only detects the presence of pathogens associated with chronic endometritis. A negative result does not rule out the presence of other endometrial pathogens.
  • The tests are not 100% accurate at determining the bacterial species.

Why use ALICE?

  • ALICE is a diagnostic test to detect and quantify the most common pathogenic bacteria causing chronic endometritis, recommending appropriate antibiotic and probiotic treatment
  • ALICE uses the latest Next Generation Sequencing (NGS) technology to provide microbiome information in endometrial tissue by analysing the abundance of specific bacteria causing chronic endometritis
  • Using NGS allows the identification of culturable and nonculturable endometrial pathogens associated with chronic endometritis
  • If the ALICE test is positive, the report will focus on the detection of the specific bacteria causing the condition
  • A list with the recommended antibiotics and probiotics will be provided depending on ALICE results
  • Microbiology counselling is available
Documentation & Resources
  • ALICE Specialists' documents

Clinical Sheets

Download

FAQs

Download

EndomeTRIO Manual

Download
Scientific evidence

Relevant related studies:

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. 

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Other services you may be interested in

ERA

Evaluates the endometrial receptivity

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EMMA

Evaluates the endometrium at the microbiological level

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EndomeTRIO

A new dimension of endometrial health

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