Fertility Decoded

Endometrial microbiome test (EMMA/ALICE)

A biopsy analysing the womb's bacteria, claimed to guide antibiotic or probiotic treatment before transfer.

Written by Fertility Decoded. Reviewed by D R, MS (OBG), FRM. Review date: 31 August 2026.

The verdict

Not shown to improve your chance of a baby.

Who are these bodies?

HFEA
— UK fertility regulator; rates add-ons by evidence (traffic-light).
ESHRE
— European fertility society; evidence-based practice guidance.
NICE
— UK health-guidance body; what the NHS will and won't fund.
ISAR
— Indian Society for Assisted Reproduction; Indian expert consensus.
Cochrane
— Independent global reviewers of the underlying studies.

  • HFEA

    UK regulator

    Red — may reduce effectiveness — chance of a baby
    Source

  • ESHRE

    European society

    Not recommended

    Not recommended (same endometrial-receptivity-test family).

    Source

  • NICE

    UK NHS guidance

    Do not offer (2026)

    NG257 1.41.1 names it explicitly under 'do not offer endometrial receptivity testing... including microbiological analysis (endometrial microbiome metagenomic analysis, analysis of infectious chronic endometritis)'.

    Source

  • ISAR

    Indian society

    No position

    Not addressed in the 2021 ISAR add-ons consensus.

  • Cochrane

    Evidence base

    No Cochrane review identified specifically for this add-on.

Typical cost in India

~₹30,000–50,000 (often sold alongside ERA); approximate.

Sources

Take this further

Sources last reviewed .