EndomeTRIO is the combined endometrial panel from the Igenomix laboratory: ERA, EMMA and ALICE run together on one sample of womb lining. The panel is £1,450, and every patient sees one of our gynaecologists for a £300 consultation first — that consultation is charged separately, on top of the test price.
One thing you deserve to know before you read any further: the HFEA, the UK’s statutory fertility regulator, rates endometrial receptivity testing — the ERA part of this panel — red. We set out what that means immediately below, and why some patients choose EMMA and ALICE without ERA for £890 instead.
Available atLPC City (E1)
EndomeTRIO contains the ERA test, and the Human Fertilisation and Embryology Authority (HFEA) — the UK’s statutory fertility regulator — gives endometrial receptivity testing a red rating on its treatment add-ons list. The HFEA defines red as: there are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness. The main study behind that rating is a multicentre, double-blind randomised controlled trial of 767 patients published in JAMA in 2022, which compared ERA-timed with standard-timed transfer of a single chromosomally normal frozen embryo and found no difference in live birth rates. You can read the regulator’s own assessment on the HFEA treatment add-ons page. EMMA and ALICE are not currently rated by the HFEA — that is not an endorsement, it only means the regulator has not assessed them. We offer EndomeTRIO because some patients and their fertility consultants ask for it, and we think anyone considering it should have the evidence set out plainly first.
EndomeTRIO is a combined endometrial panel made by the genetics laboratory Igenomix. It bundles three separate tests — ERA, EMMA and ALICE — and runs all three on one small sample of womb lining, taken in a single outpatient biopsy at our London clinic.
The three tests ask different questions of the same tissue. ERA measures the expression of a panel of endometrial genes to estimate where your window of implantation falls, and therefore on which day an embryo transfer would theoretically be best timed. EMMA sequences the bacteria present in the lining and reports how far the sample is dominated by Lactobacillus species. ALICE looks specifically for the organisms associated with chronic endometritis, a low-grade, usually symptomless inflammation of the womb lining.
The panel is aimed at people who have had embryos transferred more than once without a pregnancy, or who have had repeated early losses. If that is you, you have probably been offered a long list of extras by now, and you are the person this page is written for. Our fertility services page sets out everything we do in this area, and recurrent miscarriage covers the investigations that usually come first.
The genuine advantage of the combined panel is practical rather than clinical: one biopsy, one appointment, one recovery, three results. Where a patient has already decided they want more than one of these tests, running them together avoids a second procedure and a second wait. That is a real benefit. It is a convenience benefit, though, not evidence that any of the testing changes what happens next.
The cluster
Each has its own page, with its own evidence and its own price. You are not obliged to take all three — see why you may not need all three below.
Estimates where your window of implantation falls, so a transfer could be re-timed. This is the component the HFEA rates red, and the ERA test page goes through the trial evidence in full.
Sequences the bacteria in the womb lining and reports how Lactobacillus-dominant it is. The £890 price includes ALICE. Not currently rated by the HFEA. More on the EMMA test page.
Looks for the specific organisms linked to chronic endometritis, an inflammation of the lining that can be treated with a course of antibiotics. Detail on the ALICE test page.
The numbers that matter before you decide anything.
Comparison
What each component measures, what a result could realistically change, how strong the evidence behind it is, and what it costs on its own. Every price below is the test only — the £300 gynaecology consultation is charged separately in every case. Full detail sits on the ERA, EMMA and ALICE pages.
| ERA | EMMA | ALICE | |
|---|---|---|---|
| What it measures | Expression of a panel of endometrial genes, to estimate where your window of implantation falls | The bacterial make-up of the womb lining, including how far it is dominated by Lactobacillus | The presence of specific organisms associated with chronic endometritis |
| What a result could change | The day on which your clinic schedules an embryo transfer | Whether probiotics, or antibiotics for a dysbiotic profile, are discussed with your clinic | Whether a targeted course of antibiotics is discussed with your clinic |
| Type of evidence behind it | Randomised controlled trials — and the largest, in 767 patients, found no live birth difference | Observational only. Association between a non-Lactobacillus profile and poorer outcomes; no trial showing that treating it helps | Indirect. Chronic endometritis is a recognised condition, but trials of antibiotic treatment conflict |
| HFEA rating | Red | Not rated | Not rated |
| Price as a standalone test | £1,100 | £890 (ALICE included) | £665 |
| Gynaecology consultation | £300 extra | £300 extra | £300 extra |
| Included in EndomeTRIO £1,450 | ✔ | ✔ | ✔ |
Red is the most negative rating on the HFEA’s scale — not simply the bottom of a ranking, and not the same as “not yet rated”. It means there are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness.
“Not rated” means the HFEA has not assessed EMMA or ALICE. It does not mean the regulator considers them effective.
All three tests are run from the same biopsy. The combined panel saves you a second procedure; it does not make any individual test more informative.
We would rather say this plainly than have you work it out afterwards. The combined panel is £1,450. EMMA on its own is £890 and includes ALICE in that price, so leaving ERA out keeps two of the three tests and costs £560 less. ALICE by itself is £665. The same £300 consultation applies whichever you choose.
The reason to consider leaving ERA out is not that it is a poor laboratory assay. It is that the strongest evidence available says re-timing a transfer on the basis of it does not change live birth rates.
The 2022 JAMA trial randomised 767 patients to ERA-timed or standard-timed transfer of a single chromosomally normal frozen embryo, with neither the patients nor their clinicians knowing which arm they were in, and reported live birth in 58.5 per cent of ERA-timed transfers against 61.9 per cent of standard-timed ones.
An earlier multicentre trial of 458 patients, run by the test’s own developers, found comparable outcomes in its intention-to-treat analysis; the advantage it reported showed up only in the per-protocol analysis, after about half the participants had dropped out.
The case for EMMA and ALICE is different, though it is not a strong one either. Chronic endometritis is a real and recognised condition, it is common in this group — in one series of 106 women with unexplained infertility and repeated implantation failure it was diagnosed at hysteroscopy in 70 of them, 66 per cent — and it can be treated with antibiotics.
What remains genuinely uncertain is whether finding and treating it improves the chance of a live birth. ESHRE’s 2023 good practice recommendations say assessment for chronic endometritis can be considered and antibiotics can be considered if it is found, while noting that reviews of antibiotic treatment have produced conflicting results.
The microbiome evidence behind EMMA is observational and thin: in a study of 35 IVF patients, a Lactobacillus-dominant lining was associated with higher implantation and live birth rates than a non-Lactobacillus-dominant one. Association is not the same as cause, 35 patients is a very small sample, and no trial has yet shown that changing the microbiome changes the outcome.
So the honest position is this. If you want the fullest picture from one procedure, EndomeTRIO gives it to you. If you want the components with the least contested rationale, EMMA with ALICE at £890 is the cheaper and — in our view — more defensible half of the panel. If you want our gynaecologist’s opinion on whether any of it is worth doing in your particular case, that is exactly what the consultation is for, and the answer is sometimes no.
One more thing worth checking before you spend anything here. If you have not yet had the basic structural investigations — a pelvic scan, an endometrial lining scan, a HyCoSy or saline infusion sonohysterography, or an outpatient hysteroscopy — those come first. They cost less and they can find things that are directly treatable, such as a polyp, a fibroid distorting the cavity, or adhesions. Our full gynaecology services and fertility health check-up pages set out what those involve, and every price we charge is listed on the fees page.
Prices
Read this as a ladder. The panel is the most expensive option and ERA is the component the HFEA rates red, so the combinations that leave ERA out cost less. Whichever you choose, the £300 gynaecology consultation comes first and is charged separately — there is no bundled figure. Everything we charge is on the fees page.
| Option | What it includes | Test price |
|---|---|---|
| EndomeTRIO | ERA, EMMA and ALICE, run together on one sample | £1,450 |
| ERA on its own | Endometrial receptivity only — the component rated red by the HFEA | £1,100 |
| EMMA | Endometrial microbiome, with ALICE included in the price | £890 |
| ALICE on its own | Chronic endometritis organisms only | £665 |
| Gynaecology consultation | Required before any of the above, and charged separately | £300 |
Choosing between these is a decision about price and about which questions you want answered. It is not a decision we can attach an outcome to: we cannot tell you that any of this testing improves your chance of a live birth, and we cannot tell you that leaving it out costs you one.
The consultation is not an administrative charge. It is where a consultant gynaecologist decides with you whether any of this testing is worth doing at all.
The practical part is straightforward: a consultation, a short outpatient procedure to take the sample, then a follow-up conversation about what came back. The sample itself is small — a few millimetres of womb lining, drawn up through a fine flexible catheter passed through the cervix, in a procedure that takes a couple of minutes and does not need an anaesthetic.
What matters most is the timing. All three tests are run on tissue taken at a specific point in the cycle, because the endometrium changes character day by day under the influence of progesterone. Get the timing wrong and the sample is not interpretable.
A single endometrial sample contains both endometrial cells and the bacteria living among them, which is why one biopsy can serve all three analyses. The laboratory splits the sample and runs the gene expression analysis for ERA and the bacterial sequencing for EMMA and ALICE in parallel.
This is the strongest practical argument for the combined panel. If you have decided you want ERA and you also want the microbiome tests, taking them separately would mean two procedures, two recoveries and two mock cycles. Taken together it is one of each.
It also means you cannot change your mind halfway. Adding a test after the sample has been processed means another biopsy, so the decision about what to include is made before the procedure, at your consultation.
The sample is taken in a mock cycle — a practice run that mimics the hormonal preparation of a real embryo transfer, but without transferring anything. In a hormone-replacement cycle the biopsy is timed to a set number of days after progesterone is started; in a natural cycle it is timed from your LH surge.
Your fertility clinic and our gynaecologist agree that timing between them before anything is booked, because the protocol used for the mock cycle has to match the protocol that will be used for your actual transfer. If they differ, an ERA result cannot be applied.
This is one of the practical costs of the ERA component that is easy to underestimate: it usually means putting a transfer cycle aside to do the test. If you are considering the panel, factor that delay into your thinking as well as the price. Our IVF pregnancy monitoring and follicle tracking services can support the cycles either side of it.
An ERA report classifies the sample as receptive or non-receptive at the moment it was taken, and if non-receptive, suggests a shift of a number of hours earlier or later. It does not report a probability of pregnancy and it does not say anything about the embryo.
An EMMA report describes the bacterial composition of the lining and how far Lactobacillus dominates it. A profile with little Lactobacillus was associated with lower implantation and live birth rates in a small observational study of 35 IVF patients; the report may prompt a discussion about probiotics or, in some cases, antibiotics.
An ALICE report names any of the specific organisms linked to chronic endometritis that were found, with an indication of the antibiotics those organisms are usually sensitive to. A negative ALICE does not entirely exclude chronic endometritis, because the condition can also be diagnosed on biopsy histology and at hysteroscopy, and the different methods do not always agree.
Results come back to our gynaecologist, who goes through them with you and puts them in writing. We will also send them to your fertility clinic, which is usually the more important step — the clinic performing your transfer is the one that decides whether to act on any of this.
It is worth asking your clinic in advance what they will do with the results, because clinics differ. Some will re-time a transfer on an ERA report; others follow the HFEA rating and will not. Finding that out before you pay for the test is a great deal less frustrating than finding it out afterwards.
If a treatable finding does come back — chronic endometritis being the clearest example — the treatment is usually a course of antibiotics prescribed and supervised by whoever is managing your care, followed by a decision about whether to retest.
No test on this page is a routine investigation, and none of it belongs at the start of a fertility journey. These are the circumstances in which patients most often raise it with us, and in which a conversation about it is reasonable.
You have had several good-quality embryos transferred, in well-prepared cycles, without a pregnancy
Chromosomal testing of your embryos has already been done, so embryo quality is less likely to be the explanation
The structural investigations — scan, hysteroscopy, cavity assessment — have already been done and were normal
Your own fertility consultant has specifically asked for one or more of these tests before your next transfer
You have had repeated early pregnancy losses and are working through the recurrent miscarriage investigations
You understand the HFEA rating, you have read the trial evidence, and you still want the information
You would rather have one procedure than two, and you want more than one of the three tests
You cannot book this test directly, and we do not offer it as a standalone purchase. Every patient has a consultation with one of our consultant gynaecologists first. The consultation is £300, and the test price — £1,450 for the full panel — is charged on top of it. There is no bundled figure, because the consultation is a genuine clinical gate rather than an administrative step.
The reason is that most of the value in this appointment lies in deciding what, if anything, to test. Your gynaecologist will go through your history, your previous cycles, what has already been investigated and what your own fertility clinic is expecting. Several people who arrive intending to have the full panel leave having decided on EMMA and ALICE only, or on nothing at all until an outpatient hysteroscopy has been done. We think that is the consultation working properly, not failing.
If you do go ahead, the same consultation covers the practical planning: which cycle protocol the biopsy will be taken in, how that fits with your transfer plans, and what your clinic will and will not act on. If you are earlier in the process than this, our fertility health check-up and trying to conceive pages are the better starting points, and the fees page lists everything we charge.
This page is general information, not medical advice, and nothing on it is a recommendation that you have any of these tests. Endometrial receptivity testing is rated red by the HFEA, and neither we nor anyone else can tell you that EndomeTRIO, ERA, EMMA or ALICE will improve your chance of having a baby. Decisions about testing and treatment should be made with the clinician managing your fertility care, who knows your full history.
Your questions answered
EndomeTRIO is a combined endometrial panel from the Igenomix laboratory that runs three tests on a single biopsy of womb lining: ERA, which estimates where your window of implantation falls; EMMA, which sequences the bacteria in the lining; and ALICE, which looks for the organisms linked to chronic endometritis.
It is marketed for people with repeated implantation failure or recurrent pregnancy loss. It is an add-on to IVF rather than part of standard care, and it is not routinely offered on the NHS.
The single-biopsy design is the practical argument for it: if you want more than one of the three tests, taking them together saves you a second procedure and a second mock cycle.
The EndomeTRIO panel is £1,450 at London Pregnancy Clinic. On top of that, the £300 gynaecology consultation is required before testing and is charged separately, so those are two figures rather than one.
The individual tests are also available: ERA is £1,100, EMMA is £890 and includes ALICE in that price, and ALICE on its own is £665. The same £300 consultation applies to each.
Every price we charge is listed on our fees page. There is no cheaper route that skips the consultation, because we do not sell any of these tests without one.
The HFEA rates treatment add-ons on the quality of the evidence behind them. Red means there are potential safety concerns and/or, on balance, the findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness. That is the rating currently given to endometrial receptivity testing, which is the ERA component of EndomeTRIO.
The main study behind it is a multicentre, double-blind randomised controlled trial published in JAMA in 2022. It randomised 767 patients to have a single chromosomally normal frozen embryo transferred either on an ERA-timed day or on the standard day, and found live birth in 58.5 per cent of the ERA-timed group against 61.9 per cent of the standard-timed group — no meaningful difference, and if anything a slightly lower figure in the tested arm.
You can read the regulator’s reasoning yourself on the HFEA treatment add-ons page. We would rather point you at it than paraphrase it.
No. Neither EMMA nor ALICE appears on the HFEA’s rated add-ons list at present. It is important to read that accurately: not rated means the regulator has not assessed them, not that it considers them effective.
The evidence behind them is different in kind from the ERA evidence rather than stronger. Chronic endometritis is a recognised condition, and ESHRE’s 2023 recommendations say assessment for it can be considered in recurrent implantation failure, with antibiotics considered if it is found — while noting that trials of antibiotic treatment have produced conflicting results.
The microbiome work behind EMMA is observational, and small. In a study of 35 IVF patients, a Lactobacillus-dominant lining was associated with higher implantation and live birth rates than a non-Lactobacillus-dominant one — but no randomised trial has shown that altering the microbiome alters the outcome.
Yes, and a fair number of our patients do. EMMA is £890 and includes ALICE in that price, so choosing it over the full panel keeps two of the three tests and costs £560 less than EndomeTRIO. ALICE on its own is £665.
This is the option we most often end up discussing with people who arrive asking for the full panel. It leaves out the component the HFEA rates red and keeps the two whose rationale is less contested, and it still needs only one biopsy.
It is your decision, and we will run whichever combination you and your gynaecologist settle on. We simply think you should know the cheaper option exists before you pay for the more expensive one.
Yes — it is not optional, and you cannot book the test directly. Every patient having ERA, EMMA, ALICE or the combined EndomeTRIO panel sees one of our consultant gynaecologists first. The consultation is £300 and the test price is charged on top of it.
That appointment decides what is actually worth testing, checks that the more basic investigations have been done, and sorts out the cycle timing with your fertility clinic. Without it there is a real risk of taking a sample that cannot be interpreted or acted on.
You can book the gynaecology consultation online, or call us on 020 3687 2939 if you would rather talk it through first.
In a mock cycle — a rehearsal of the hormonal preparation used for an embryo transfer, without an embryo being transferred. In a hormone-replacement cycle the biopsy is timed to a set number of days after progesterone is started; in a natural cycle it is timed from your LH surge.
The protocol used for the mock cycle has to match the protocol planned for your real transfer, which is why your gynaecologist agrees the timing with your fertility clinic in advance. If the two do not match, an ERA result cannot be applied to your transfer.
Practically, this usually means setting a transfer cycle aside to do the test. That delay is a genuine cost of the ERA component, and worth weighing alongside the price.
Most people describe it as period-type cramping that lasts a minute or two rather than pain. A fine flexible catheter is passed through the cervix and a small sample of lining is drawn up. No anaesthetic is needed and you can go home straight afterwards.
If you would like to take a painkiller beforehand, ask us at your consultation what would suit you — we will talk you through the whole procedure before we start. Some light spotting for a day or so afterwards is normal.
If your cervix has been difficult to pass in the past, or if you have found similar procedures very uncomfortable, tell us at the consultation. It changes how we plan the appointment.
The report will suggest shifting the timing of progesterone before transfer by a number of hours, earlier or later. Whether that shift is then used is a decision for the clinic performing your transfer, not for us.
It is worth being clear about what the result does not tell you. It says nothing about the embryo, nothing about your chance of pregnancy, and — on the evidence of the JAMA trial — acting on it did not produce more live births than transferring on the standard day.
A displaced result can also feel like an explanation for previous failed transfers, and that is an understandable and very human response to it. We would gently caution against reading it that way, because the trial evidence does not support the idea that correcting the timing fixes the problem.
If ALICE identifies organisms associated with chronic endometritis, the usual next step is a targeted course of antibiotics, prescribed and supervised by whoever is managing your fertility care, sometimes followed by a repeat test to confirm it has cleared.
If EMMA shows a lining with little Lactobacillus, the discussion is usually about probiotics or, in some cases, antibiotics. The honest position here is that we know a non-Lactobacillus-dominant profile is associated with poorer outcomes; we do not know that changing it improves them.
In both cases the treatment decision belongs with your fertility clinic, and we send the report to them as well as to you.
Some will act on them and some will not, and it is genuinely worth asking before you book. Clinics that follow the HFEA ratings closely often decline to re-time a transfer on an ERA report, while being more willing to treat a positive ALICE result.
We send your results directly to your clinic if you would like us to, along with the report from our gynaecologist. Many overseas clinics ask UK patients to have these tests locally, which is one of the more common reasons patients ask us for them.
If your clinic has told you it will not use the results, that is a strong argument for not paying for the test at all — and we would say so.
They answer completely different questions. An outpatient hysteroscopy is a camera examination that looks at the shape and surface of the uterine cavity and can find and treat polyps, fibroids and adhesions in the same appointment. EndomeTRIO is a laboratory analysis of a tissue sample and sees nothing at all.
Endometrial scratching is a different thing again — a deliberate minor injury to the lining intended to provoke a repair response, rather than a test. The HFEA gives it two separate ratings: yellow for IVF and ICSI patients in general, meaning the moderate-to-high quality evidence conflicts and it is not clear whether it works; and grey for patients with recurrent implantation failure, meaning there is not enough good-quality evidence to rate it at all for that group.
If nothing has yet looked at the inside of your uterus, a hysteroscopy or a cavity assessment such as saline infusion sonohysterography is usually the more useful place to start, because those can find problems that are directly fixable.
It is not routinely available on the NHS. Endometrial receptivity testing is an IVF add-on rather than part of standard fertility care, and its red HFEA rating makes NHS funding for it very unlikely.
Private medical insurance rarely covers fertility add-ons, and where a policy covers fertility investigations at all it often excludes tests of this kind. Check with your insurer before assuming, and ask specifically about the test name rather than about fertility investigations in general.
Our fees are transparent whichever route you take: £300 for the consultation, then £1,450 for EndomeTRIO, £1,100 for ERA, £890 for EMMA including ALICE, or £665 for ALICE alone. Everything is on the fees page.
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The figures and clinical statements on this page are drawn from the sources below. Guidance evolves — always discuss your individual circumstances with a clinician.
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