EndomeTRIO–Alice, Emma, Era. What is the meaning of these names? How can they help in trying to have a baby?

Articles, News 28. June, 2019

Infertility Is caused by a number of factors, but did you know that one of the reasons you can’t have a baby could be the unfavorable conditions in your uterus? Are there any tests that can evaluate the uterine environment and at the same time determine the optimal moment to introduce the embryo?

What is the endometrium?

The endometrium is the mucous layer of the uterus where the fertilized egg is attached. The endometrium, or uterine mucosa, located in the innermost part of the uterine wall, is a key factor for a successful pregnancy. Uterine mucosa is commonly evaluated by ultrasound scanning, which is only able to assess its thickness and structure. However, bacterial flora (microbioma) and the implantation window, which is the optimal time period to transfer the embryo to the uterus, are also of great importance.

Due to a hormonal imbalance in the woman’s body (estrogen dominance over progesterone), the uterine mucosa may also grow outside the uterus, a disorder known as endometriosis.

Bacteria in the uterus prevent the successful nesting of the embryo.

Endometrial bacterial balance is important for successful embryo implantation. If pathogenic bacteria are present in the uterus, this balance may be impaired. The test called ALICE (Analysis of Infectious Chronic Endometritis) can detect the presence of these chronic inflammatory bacteria. This inflammation, occurring in up to 30% of infertile patients, may be one of the causes of repeated miscarriages. However, this situation can be managed by appropriate treatment.

Other bacteria causing female infertility can also be identified by taking a uterine mucosa sample and its subsequent analysis with new generation sequencing (NGS). EMMA (Endometrial Microbiome Metagenomic Analysis) can provide a complete overview of the composition of the uterine mucosa. In the event of a non-optimal bacterial pattern, EMMA can suggest appropriate antibiotic or probiotic treatment. The ALICE test is included in the EMMA kit.

Is now the right time to transfer the embryo?

Repeated unsuccessful embryo transfer can be difficult for a woman, both physically and mentally. Although the couple has completed a series of tests and their embryos are prepared for transmission to the uterus according to the results of pre-implantation genetic testing, the uterine mucosa may not be ready for this transfer.

The Endometrial Receptivity Analysis (ERA) test can be used to determine the implantation window, i.e. the exact time the uterine mucosa is ready for nesting. Its results will also help determine appropriate hormonal pre-treatment and its length. Using this test, a 73% Implantation Rate is achieved in patients with repeated implantation (nesting) failure.