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ENDOME TRIO

What is EndomeTRIO?
The EndomeTRIO test aims to analyze a woman& endometrial health in a very comprehensive way. To do this, we need to do an endometrial biopsy from which 3 different tests are performed: ERA, EMMA and ALICE. Each of these tests provides relevant information on the condition of the endometrium.

Indications of EndomeTRIO

 Repeated Implantation failures
 Repeated miscarriage
 Chronic Endometritis
 Endometriosis
 Hydrosalpinx
 Previous sexually transmitted diseases


What is the procedure for the EndomeTRIO test


The first step to perform EndomeTRIO is to perform an endometrial biopsy on the
patient and take a sample. When considering the best day to do the endometrial
biopsy, there are two options:


EndomeTRIO with ERA test


The endometrial biopsy should be taken under the same conditions under which
the embryo transfer will subsequently be performed, i.e. in a substituted cycle or in
a natural cycle. In the first case, the biopsy will be performed on day P+5 of progesterone administration, with day P+0 being taken on the first day of
progesterone intake. In case of being in a natural cycle, the endometrial biopsy will be performed 7 days after the  hCG  injection, that is, on day hCG+7.

EndomeTRIO without ERA test

If only the EMMA and ALICE tests are performed, the endometrial biopsy can be
taken between days 15 and 25 of the menstrual cycle.


ERA test


The ERA (Endometrial Receptivity Array) test is a molecular test that aims to identify the exact days of the implantation window and thus schedule the embryo transfer at the most suitable time. To identify exactly which days of the cycle the endometrium is receptive, the expression of 248 genes is studied using the mass sequencing technique (NGS).
The result of the ERA test will indicate the state of the endometrium at the time of the biopsy: receptive, early receptive, late receptive, non receptive, etc.

EMMA test

The EMMA test (Endometrial Microbiome Metagenomic Analysis) analyses the endometrial microbiome, i.e. the type and number of microorganisms in the uterine cavity, to determine whether it is optimal or not.

Recent studies have shown that pathogenic deviations in the levels of endometrial Lactobacilli and dysbiotic bacteria can lead to infertility, hence the importance of studying the microbial environment of the uterus. The results of the EMMA test will include the percentage of Lactobacilli or other bacteria detected, as well as suggested antibiotic or probiotic treatment if necessary. 

ALICE test

The ALICE (Analysis of Infectious Chronic Endometritis) test is a molecular test to diagnose chronic endometritis, which affects approximately 30% of infertile patients.

Chronic endometritis is a uterine infection caused by pathogenic bacteria that results in persistent inflammation of the endometrium.

The ALICE test identifies the pathogenic bacteria that cause chronic endometritis and how much of it is found in the endometrium. These bacteria are Enterococcus sp., Enterobacteriaceae (Escherichia and Klebsiella), Streptococcus sp., Staphylococcus sp., Mycoplasma sp., and Ureaplasma sp. ALICE also identifies other pathogenic bacteria associated with  sexually transmitted diseases, such as Chlamydia and Neisseria. Additionally, ALICE provides information on the most recommended antibiotic and/or probiotic treatment to cure endometritis.