ERA, EMA, ALICE

ERA (Endometrial Receptivity Analysis): Timing Matters EMA and ALICE: Microbiome and Silent Inflammation Clinical Integration: The Patient Procedure

The ERA, EMA, and ALICE tests at Gynatal Clinic (Timișoara) offer a comprehensive assessment of endometrial health. While ERA determines the precise implantation window, EMA (imMAP) analyzes the uterine microbiome, and ALICE (IHC CD138) detects chronic inflammation (endometritis). This triad significantly increases success rates for RIF patients by personalizing embryo transfer at a molecular level.

ERA (Endometrial Receptivity Analysis): Timing Matters

The ERA test is a genetic investigation that examines the expression of 248 genes in the endometrium to determine exactly when the lining is most receptive to an embryo.

The Problem: In approximately 30% of women, the "implantation window" (fereastra de implantare) does not open on the standard Day 5 after ovulation or progesterone initiation.
The Solution: A biopsy determines if a patient is pre-receptive or post-receptive, allowing Gynatal specialists to perform a pET (Personalised Embryo Transfer) with hourly precision.

EMA and ALICE: Microbiome and Silent Inflammation

At Gynatal, these analyses are integrated into our advanced protocols under the names imMAP (Endometrial Microbiome Mapping) and IHC.

EMA (imMAP) – Finding Bacterial Balance

This test investigates whether there are enough beneficial lactobacilli in the uterus to support a pregnancy.

Scientific Gold Standard: For successful nidation, the endometrium should ideally consist of more than 90% lactobacilli.
Dysbiosis: If pathogenic bacteria predominate, the chances of a live birth decrease, even with high-quality embryos verified by ni-PGT-A.

ALICE (IHC CD138) – Detecting Chronic Endometritis

This analysis searches for plasma cells (the CD138 marker) which signal chronic inflammation of the uterine lining.

Silent Inflammation: This condition is often asymptomatic and invisible on standard ultrasound, yet it remains toxic to the embryo.
Treatment: Once identified, we implement a targeted antibiotic or probiotic course before the transfer to restore the environment.

Clinical Integration: The Patient Procedure

To reduce Anxiety and Cognitive Friction, Gynatal can perform all three analyses from a single tissue sample collected during one outpatient biopsy.

Biopsy: Performed in an outpatient setting without the need for anesthesia.
Results: Typically available within 2–3 weeks.
Personalized Transfer: Conducted in a subsequent cycle using the molecular data to maximize the chance of a positive HCG test.