Endometrial Analysis (ERA, ALICE, EMMA)

Endometrial analysis refers to a group of specialised tests that assess the condition of the uterine lining (endometrium), which plays a crucial role in embryo implantation.

At Sunfert, we use endometrial analysis to better understand why implantation may not be occurring as expected, even when good-quality embryos are available. These tests provide deeper insights beyond standard scans, helping our fertility specialists to personalise fertility treatment.

In simple terms, endometrial analysis helps us answer:

• Is the uterus ready for embryo implantation?
• Are there hidden infections or inflammation?

Is the uterine environment supportive for pregnancy?

• Endometrial Receptivity Analysis (ERA)
• Endometrial Microbiome Metagenomic Analysis (EMMA)
• Analysis of Infectious Chronic Endometritis (ALICE)

What is Endometrial Receptivity Analysis (ERA)?

Endometrial Receptivity Analysis (ERA) is a molecular test that determines the optimal timing for embryo transfer by identifying a patient’s unique “window of implantation.”

For most women, endometrial receptivity, which is the period when the uterus is ready for an embryo to implant, can be predicted based on the number of days after ovulation. However, in some cases, this window may occur earlier or later than expected.

ERA evaluates the endometrial lining at a molecular level to determine whether the timing of embryo transfer should be adjusted to align with the individual’s specific window of implantation.

Transferring an embryo outside this optimal window may reduce the chances of successful implantation during IVF treatment.

ERA is commonly recommended for patients who:

• have experienced repeated IVF implantation failure
• have good-quality embryos but unsuccessful transfers
• are seeking personalised embryo transfer timing

How ERA can help:

• identifies if the patient’s implantation window has shifted
• allows fertility specialists to schedule embryo transfer at the most receptive time
• improves chances of successful implantation

The ERA procedure, step by step:

1. Performed during a mock cycle (similar to IVF preparation)

2. A small sample of the endometrial lining is collected

3. The sample is analysed to determine the optimal window of receptivity

What is Endometrial Microbiome Metagenomic Analysis (EMMA)?

Endometrial Microbiome Metagenomic Analysis (EMMA) evaluates the balance of bacteria within the uterine lining, particularly the presence of beneficial bacteria, also known as "good bacteria," such as Lactobacillus.

Endometrial health is essential for a successful pregnancy. A healthy endometrium is typically rich in beneficial bacteria, forming the endometrial microbiome, which plays a key role in supporting embryo implantation.

EMMA offers a detailed analysis of this microbiome to improve reproductive outcomes. Based on the results, our fertility specialist can recommend targeted probiotic or antibiotic treatments to restore balance and enhance your chances of achieving pregnancy.

If the levels of beneficial bacteria are low, the likelihood of successful implantation and pregnancy may be reduced.

EMMA is commonly recommended for patients who:

• have experienced recurrent implantation failure
• have unexplained infertility
• are suspected of having an imbalanced uterine environment

How EMMA can help:

• detects bacterial imbalance within the uterus
• guides personalised probiotic or antibiotic treatment
• helps restore a supportive environment for embryo implantation

The EMMA procedure, step by step:

1. Conducted alongside an endometrial biopsy during a mock or treatment cycle

2. A small sample of endometrial tissue is collected

3. Advanced sequencing technology analyses the microbiome composition

4. Results are used to guide personalised fertility treatment recommendations

What is Analysis of Infectious Chronic Endometritis (ALICE)?

ALICE identifies harmful bacteria that may cause chronic endometritis, which is persistent inflammation of the uterine lining.

Chronic endometritis is a common cause of recurrent implantation failure and recurrent pregnancy loss. In many cases, this condition causes inflammation without visible symptoms, making it difficult to detect without specialised testing.

ALICE detects the specific bacteria responsible for chronic endometritis, allowing for personalised treatment to improve the success of the fertility treatment such as IVF.

Studies show that around 66% of patients with repeated implantation failures or recurrent pregnancy loss are affected by chronic endometritis.

ALICE is commonly recommended for patients who:

• have experienced repeated IVF failure
• have had recurrent miscarriage
• are suspected of having an underlying uterine infection

How ALICE can help:

• detects specific bacteria causing chronic endometritis
• enables targeted antibiotic treatment
• reduces inflammation and improves the chances of successful embryo implantation

The ALICE procedure, step by step:

1. A small endometrial biopsy sample is collected

2. The sample is analysed for pathogenic bacteria

3. Results are used to guide personalised fertility treatment

If you are facing fertility challenges, start with a consultation with our specialists. We will guide you through your fertility journey with expertise and compassionate care. 

Make an appointment with our Fertility Specialist today and take the next step toward your parenthood goals.

Question #1: What is the purpose of endometrial analysis in IVF?

• Endometrial analysis helps determine whether the uterine lining is receptive and free from infection, improving the chances of successful embryo implantation.

Question #2: Is the procedure painful?

• The procedure may cause mild discomfort, similar to menstrual cramps, but it is generally quick and well tolerated.

Question #3: When should I consider endometrial analysis?

• You may consider it if you have experienced repeated embryo implantation failure in your IVF treatment, recurrent miscarriage, or unexplained infertility.

Question #4: Can these tests be done together?

• Yes, ERA, EMMA, and ALICE are often performed using a single biopsy sample, making the process more efficient and convenient.

Question #5: How long does it take to get results?

• Results typically take a few weeks, depending on the type of analysis performed, after which a personalised fertility treatment plan will be discussed.