What is the Alice test in IVF?

What is the Alice test in IVF?

In Vitro Fertilization (IVF) is the first treatment option that comes to mind for couples who are unable to conceive naturally. With new techniques that are developing constantly, IVF increases the chances for couples to become parents.

Fertility professionals now have the advanced technologies to determine the causes when pregnancy tests consistently come back negative or embryo transfers in IVF cycles fail, thanks to the efficiency of fertility and genetic testing with the development of technology. 

Successful embryo implantation is mandatory for a successful result in IVF. For this, the health of the endometrium (inner surface of the uterus) is extremely important. Recurrent miscarriages and unsuccessful implantation may be linked to pathogenic microorganisms that can lead to chronic endometritis. There are some diagnostic tests to detect and treat this condition.

What is the Alice Test?

The diagnostic test ALICE (Analysis of Infectious Chronic Endometritis) detects harmful bacteria and can aid the physician to prescribe the right probiotic or antibiotic medication, increasing their chances of getting pregnant. (1)

Only a little amount of endometrial tissue, which is easily taken in the clinic, is required for the ALICE test. It covers a simple operation that doesn’t require anesthesia. 

The most recent Next Generation Sequencing (NGS) technology is then used to evaluate the sample and provide a comprehensive profile of the bacteria present in the tissue. In addition, the ALICE test, which identifies the bacteria that cause chronic endometritis, is a component of EMMA(Endometrial Microbiome Metagenomic Analysis). (2)

Who should have the Alice test?

For women who are experiencing infertility, ALICE is a good option that can improve reproductive success. (3)

The ALICE test is helpful for any patient considering conception since it provides detailed information about the microbiological environment that the embryo will experience in the implantation process. 

In order to determine whether chronic endometritis is an underlying disorder and a contributing factor to fertility issues, the test is also advised for patients who experience recurrent implantation failures or miscarriages. (4)

How does the Alice test work?

The ALICE test requires only a small endometrial sample. This process consists of 5 steps:

  1. Taking an endometrial sample
  2. DNA extraction
  3. Bacterial analysis by NGS (Next Generation Sequencing)
  4. Report
  5. Treatment 

ALICE allows accurate information that facilitates efficient treatment and enhances patient reproductive outcomes. The report will focus on identifying the particular bacteria causing the disorder if the ALICE test is positive. (5)

How does the Alice test result affect the IVF process?

The data obtained as a result of the ALICE test, which gives information about the intrauterine tissue of the expectant mother, is of great importance. An additional treatment plan can be applied if necessary in light of these data. The embryo is then transferred into the uterus when the intrauterine tissue is the most suitable.

Indeed some of the failures in IVF treatments in Turkey may occur due to inflammation of the inner lining of the uterus. With the ALICE test, all endometrial issues due to a skewed bacterial microflora are identified allowing a treatment with simple probiotic or antibiotic treatment. 

In this way, the success percentage of the IVF treatment can be improved as with the results obtained from the ALICE test, the uterine environment  will be properly prepared thus ensuring a healthy pregnancy. 

Limitations of the ALICE Test

The ALICE test, while beneficial, presents constraints worthy of consideration. Primarily, its focus is narrow, honing in exclusively on certain bacteria linked to chronic endometritis. Consequently, it might overlook additional causes behind implantation failure or miscarriage. Additionally, as a relatively recent addition to fertility diagnostics, the ALICE test lacks comprehensive long-term data. This absence raises questions about its full potential in enhancing IVF success rates over time. Furthermore, the treatment path following a positive ALICE test result leans heavily on antibiotics and probiotics. This regimen, while necessary, carries potential side effects and does not ensure a successful IVF outcome.

Moreover, the test is not an all-encompassing solution. Even a negative result does not eliminate the possibility of other factors impeding implantation. The complexities and nuances surrounding fertility and implantation necessitate a broader diagnostic approach. For individuals navigating the IVF journey, it is crucial to engage with healthcare professionals specializing in infertility. Such discussions will illuminate how the ALICE test fits into a comprehensive IVF strategy, tailored to individual needs and circumstances.


Nakhuda, G. What is the microbiome, and who are EMMA and ALICE?.

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