ALICE Analysis of Infectious Chronic Endometritis

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.