ALICE Test for Chronic Endometritis in London

ALICE stands for Analysis of Infectious Chronic Endometritis. It is a molecular microbiology test run by the laboratory Igenomix on a small endometrial biopsy — a few millimetres of womb lining taken in clinic.

Instead of trying to grow bacteria in a culture dish, it sequences bacterial DNA from the sample, so it detects organisms that will not culture. If pathogens are found, the report names them and suggests an antibiotic likely to be active against them.

It answers one narrow question well: are the bacteria associated with chronic endometritis present in your womb lining? It does not assess the whole endometrial microbiome — that is EMMA — or the timing of your implantation window, which is ERA.

Chronic endometritis is a persistent, low-grade inflammation of the endometrium caused by bacteria colonising the uterine cavity. Almost certainly you would not know. It is usually completely silent — no pain, no fever, no abnormal discharge — which is why it is described in the literature as a silent condition and why it goes undetected.

Occasionally there are soft clues: light spotting between periods, mild pelvic discomfort, or a history that raises suspicion — previous pelvic inflammatory disease, retained products after a miscarriage or birth, a long-standing coil, or previous uterine surgery.

Because symptoms are unreliable, diagnosis rests on tissue or molecular testing rather than on how you feel. The histological standard is five or more CD138-positive plasma cells across ten high-power fields of an endometrial biopsy.

The ALICE test is £665. That figure is for the test itself and is charged on top of the £300 gynaecology consultation, which you need to have first — so the minimum outlay if you proceed is the consultation plus the test.

We deliberately do not quote a single bundled figure, because the consultation is not a formality you are paying to get past. It is where the decision about whether to test at all gets made, and a good number of those conversations end with us advising against testing.

Our other endometrial tests are EMMA at £890, ERA at £1,100 and EndomeTRIO at £1,450, each also plus the £300 consultation. Everything is listed on our fees page.

No. Every endometrial test we offer is arranged only after a gynaecology consultation with our team, and there is no route to book the test on its own.

The reason is straightforward. These tests are frequently sold to people who have already spent a great deal on treatment and are being offered hope rather than information. Whether testing makes sense for you depends on your history, what has already been investigated and what you would actually do with the result — none of which can be established by a booking form.

You can book a gynaecology consultation online, or call us on 020 3687 2939 if you would rather talk it through first.

ALICE is not currently rated by the HFEA. Its treatment add-ons list does not include testing for chronic endometritis or for the endometrial microbiome, so there is no traffic light rating for ALICE in either direction.

It is important not to read that as approval. An absent rating means the regulator has not assessed the test, nothing more. Where the HFEA has assessed a related endometrial test — endometrial receptivity testing — it rated it red, meaning there are potential safety concerns and/or that moderate to high quality evidence suggests the add-on may reduce treatment effectiveness. That applies to ERA and to EndomeTRIO.

The nearest thing to a professional position on chronic endometritis is ESHRE’s 2023 good practice recommendations on recurrent implantation failure, which say assessment for it can be considered, and that if it is diagnosed, antibiotic treatment can be considered. That is deliberately permissive language, not a recommendation to test everyone.

A fine flexible catheter is passed through the cervix and a small sample of lining is drawn up. It takes a minute or two, is done in the outpatient room and does not need an anaesthetic.

Most women feel strong period-type cramping while the sample is taken, which eases within a few minutes. Taking ibuprofen or paracetamol about an hour beforehand genuinely helps. Light spotting for a day or two afterwards is normal; heavy bleeding, fever or worsening pain is not, and you should contact us if that happens.

If you are having an outpatient hysteroscopy anyway, the biopsy can be taken during the same appointment, which spares you a second procedure and lets your gynaecologist see the cavity at the same time.

The sample is normally taken in the second half of the cycle, after ovulation, when the lining is receptive — or at the equivalent point of a medicated cycle if you are on hormone replacement for a frozen transfer.

You should not be taking antibiotics at the time, and recent antibiotic use can affect the result, so tell your gynaecologist if you have had a course within the past few weeks.

Your consultation is where the exact timing gets planned around your cycle or your treatment protocol. If your cycles are irregular, follicle tracking can pin the timing down accurately.

Your gynaecologist prescribes a targeted course of antibiotics, guided by the organisms identified, and usually lasting one to two weeks. You are reviewed afterwards.

We would then recommend a repeat biopsy to confirm the inflammation has cleared, rather than assuming it has. This matters more than it sounds: the encouraging evidence in this area applies specifically to women in whom chronic endometritis was shown to have resolved, not to women who merely took a course of antibiotics.

If the condition persists, the discussion moves to second-line agents — and, sometimes, to whether the original diagnosis should be revisited. Persistent chronic endometritis after standard treatment is not rare.

We cannot tell you that, and we would be suspicious of anyone who does. No randomised controlled trial has shown that finding and treating chronic endometritis increases live birth rates.

What exists is observational evidence. A 2018 meta-analysis of five observational studies covering 796 women with repeated implantation failure reported better ongoing pregnancy and live birth rates in women whose chronic endometritis had been shown to clear, compared with women in whom it persisted. But observational studies cannot separate the effect of the treatment from the possibility that women whose infection clears are simply different in some other way.

Pulling the other way, a 2025 retrospective cohort of over 500 women found that those treated for chronic endometritis went on to do no better than those whose biopsy had been normal all along — on small numbers, and without comparing treated against untreated chronic endometritis — and a 2024 meta-analysis found no association between chronic endometritis and repeated implantation failure at all — though it did confirm a strong association with recurrent pregnancy loss. The honest answer is that this is a real condition with a real treatment and an unresolved evidence base.

Yes, and it is getting worse. A cross-sectional study of endometrial isolates from 244 women at a large Italian referral centre found resistance to tetracyclines — which includes the usual first-line doxycycline — rising from 64.3 per cent in 2020 to 95.7 per cent in 2024, and quinolone resistance rising from 52.4 per cent to 95.7 per cent over the same period.

Those are figures from one tertiary centre in a referred population, so they are not UK community rates, but the trend is corroborated more broadly by a 2025 expert opinion warning of a drift towards multidrug-resistant endometritis.

Practically, this is the strongest argument for the confirmatory repeat biopsy. If first-line antibiotics increasingly fail, treating and then assuming the problem is solved is exactly the wrong approach.

ALICE looks for the specific bacteria that cause chronic endometritis and reports a suggested antibiotic. EMMA profiles the wider endometrial bacterial population, including the balance of Lactobacillus, but there is no standard treatment tied to the result. ERA tries to identify when your implantation window falls so that a transfer can be timed to it.

EndomeTRIO bundles all three into one biopsy at £1,450 plus the consultation. Be aware that bundling means paying for ERA, which the HFEA rates red, alongside the other two.

Of the four, ALICE is the one where a result maps onto a defined treatment for a recognised condition. That is not the same as saying it works — see the evidence section above — but it is a genuine difference in kind.

Not necessarily, but the two complement each other and they disagree often enough that neither replaces the other. At hysteroscopy the classic signs of chronic endometritis are micropolyps, a strawberry-like mottling and stromal oedema.

In a 2025 series of 136 infertile women, hysteroscopy alone was 50.0 per cent sensitive and 76.8 per cent specific against CD138 histology: 21 per cent of the women whose cavity looked entirely normal turned out to have chronic endometritis on tissue, and of the 42 whose cavity looked suspicious only 47 per cent had it confirmed on tissue.

So a normal-looking cavity does not rule chronic endometritis out, and a suspicious-looking one does not confirm it. If you are having a hysteroscopy for another reason — bleeding, a suspected polyp, a septum — taking the ALICE biopsy at the same time is efficient and gives you two independent readings. Related structural investigations include saline infusion sonohysterography and HyCoSy.

Yes. Chronic endometritis is most often discussed in an IVF context, but the association with recurrent pregnancy loss is stronger and more consistent than the association with implantation failure, and recurrent loss affects women conceiving naturally too.

That said, we would want basic investigations done first — a pelvic scan, tubal assessment where relevant, and a general fertility health check-up — before reaching for a specialist endometrial test.

If you are conceiving naturally and have not had difficulty, this test has nothing to offer you, and we will say so. Our trying to conceive guidance is a more useful starting point.

No, though both involve instrumenting the endometrium and the two get confused. Endometrial scratching is a deliberate minor injury to the lining, performed in the hope of provoking a beneficial healing response before a transfer. ALICE is a diagnostic test performed on a biopsy sample.

They also sit differently with the regulator. The HFEA rates endometrial scratching yellow for IVF and ICSI patients generally, meaning it is not clear whether it is effective, and grey for patients with recurrent implantation failure, meaning there is not enough moderate or high quality evidence to rate it at all. Grey is the rating that applies to most women reading this page. ALICE is not rated in either group, because testing for chronic endometritis has not been assessed at all.

If a clinic has offered you both, it is worth asking clearly which is being done for diagnosis and which is being done as a treatment, because the answer changes what a reasonable price and a reasonable expectation look like.