Fertulity IVF
Fertulity IVF

ALICE The “Silent” Inflammation Hindering Successful Implantation

ALICE (Analysis of Infectious Chronic Endometritis)

ALICE (Analysis of Infectious Chronic Endometritis) is a specialized molecular test that detects pathogenic microorganisms in the endometrium responsible for inflammation that goes unnoticed in standard cultures.
This is, therefore, an inflammation that does not cause pain or fever – but can prevent implantation or lead to recurrent pregnancy loss.
In many cases, implantation failure or recurrent miscarriages are not due to obvious causes. The endometrium may appear healthy, the embryos of good quality, and yet pregnancy fails. When medicine investigates underlying barriers, one of the first suspicions is chronic endometritis.

What Is Chronic Endometritis?

Chronic endometritis is a mild, persistent inflammation of the endometrium, typically caused by bacteria such as Escherichia coli, Streptococcus, Enterococcus, or Mycoplasma/Ureaplasma. Unlike acute infections, chronic endometritis does not present with intense symptoms but alters the microenvironment of the endometrium, affecting its receptivity.
Its presence is often associated with:
Implantation failure in IVF cycles
Recurrent pregnancy loss
Reduced embryo development
Alteration of the endometrial environment
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What Causes Chronic Endometritis

Chronic endometritis is not caused by a single factor but is the result of continuous or recurring microbial disruption in the endometrium. 
Common causes include:
Cause 1

Persistent bacterial infections

Often from common pathogens such as E. coli, Streptococcus, Enterococcus, Mycoplasma, and Ureaplasma, which may not cause visible symptoms but disrupt the endometrial microbiota.
Microscope capturing precise IVF cell manipulation, supporting implantation success after chronic endometritis diagnosis via ALICE test.
Cause 2

Inadequate treatment of past inflammations

Infections that were partially treated or not followed up may leave behind residual chronic inflammation.
Close-up of ICSI procedure in lab, eggs under microscope for implantation after ALICE test detected chronic endometritis.
Cause 3

Frequent intrauterine interventions

D&C procedures, hysteroscopy, IUD insertion, or even multiple IVF attempts can increase the risk of chronic inflammation.
Pregnant woman cradling belly after successful implantation, ALICE test detected chronic endometritis as key fertility factor.
Cause 4

Disruption of the endometrial microbiome

A decrease in the normal protective bacteria (e.g. Lactobacillus) leads to imbalance in the microenvironment and favors the presence of pathogens.
Parents lovingly holding newborn after ALICE test revealed chronic endometritis, highlighting implantation success through gentle care.
Chronic endometritis is a stealthy but treatable condition. Accurate diagnosis through the ALICE test and targeted treatment are key to restoring normal endometrial balance.

How the ALICE Test Works

ALICE uses Real-Time PCR technology (quantitative polymerase chain reaction) to detect the DNA of specific pathogens frequently associated with chronic endometritis.
It is performed in conjunction with an endometrial biopsy and may be done alone or alongside EMMA and ERA tests, as part of a comprehensive and detailed evaluation of the endometrial environment.
The ALICE result reveals:
Whether there is inflammatory activity
Which exact microorganisms are involved
Which treatment strategy is recommended for their elimination
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When It Is Recommended

The ALICE test is especially recommended when:
There are recurrent implantation failures (RIF) without other obvious causes
Recurrent miscarriages have occurred
Ultrasound or histological examination shows signs of endometrial inflammation
The first IVF attempt is being planned for women with a high-risk profile

What a Positive Result Means

If the ALICE test results indicate the presence of inflammation or pathogens, the treatment strategy includes:
Antibiotic therapy
Re-testing after treatment
Waiting for the inflammation to fully resolve before attempting another embryo transfer
In many cases, proper treatment leads to a significant improvement in implantation rates. Our approach at FertUlity is not to ignore the “silent obstacles,” but to ensure that before transferring a precious embryo, the environment is truly ready to receive it.
The ALICE test is a powerful tool to detect and treat small but critical imbalances that can make a difference.
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Frequently Asked Questions About ALICE Test

Is the ALICE test painful?

The test is based on an endometrial biopsy, a short and relatively painless procedure similar to a Pap smear, performed without anesthesia.

Are there any side effects?

The ALICE test is a safe procedure with minimal side effects. Some women may experience light bleeding or cramps for a few hours after the biopsy.

If inflammation is detected, what’s the next step?

If inflammation is found, you will receive appropriate antibiotic therapy (often combined with probiotics or anti-inflammatories). A follow-up test is then recommended to assess readiness for the next IVF cycle.

Does chronic endometritis affect the chances of conception?

Yes. Treating chronic endometritis has been associated with a significant increase in implantation success rates and a reduction in miscarriage rates, especially in women with a history of previous failures.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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You don’t need to have all the answers to begin.
All it takes is one first step, and a team that truly listens.
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