The endometrium refers to the innermost lining of your uterus.
The most crucial role of the endometrium is in relation to the implantation of an embryo, where the embryo attaches itself to the endometrial lining of the uterus. Additionally, the endometrium also provides a place for the growth and development of the embryo during pregnancy. 
Because of this, the endometrium plays a paramount role in implantation, pregnancy, and reproduction.
What Is The ERA, EMMA, And ALICE Test?
The ERA, EMMA, and ALICE tests allow you and your doctor to get a clearer picture of your endometrial health.
While the success rates of in-vitro fertilisation (IVF) procedures depend on the quality of the embryo, the thickness and receptivity of your endometrium also come into play.  Therefore, your fertility specialist may recommend the ERA, EMMA, or ALICE test to go hand-in-hand with IVF procedures.
In Malaysia, the cost of the ERA, EMMA, and ALICE tests roughly lie in the thousands. However, this will depend on which fertility clinic you attend, and specific rates are usually only divulged upon request and consultation.
Let’s explore these different tests, what they do, how they help, and when you may need them.
Endometrial Receptivity Analysis (ERA) Test
The ERA test is a step forward towards enhancing the results of IVF procedures. This test aims to evaluate the endometrial receptivity of a woman and determine the optimal window of embryo implantation during IVF. 
In other words, the test will help specialists pinpoint the best window of time whereby the endometrium is the most receptive (and ready for embryo implantation), as this may vary from woman to woman. This step is performed before the embryo is transferred into the uterus during fertility treatment. 
Ultimately, this test may improve success rates in women with recurrent implantation failure. 
The ERA procedure involves the extraction of a sample of your endometrial lining. A thin tube, called a catheter, will be inserted through the cervix, and gentle suction is generated to draw out endometrial tissue. This sample will then be sent for testing.
If the results are ‘non-receptive,’ the test can be repeated until the optimal window for implantation is detected.
Endometrial Microbiome Metagenomic Analysis (EMMA) Test
The EMMA test captures a clearer picture of the endometrium’s microbial environment, hence, providing an analysis of the composition of bacteria present in your uterine lining.
Why is this important? Well, numerous studies have discovered that having a higher or lower number of certain species of bacteria can affect your fertility and the success rate of implantation during IVF. 
Following the results of the EMMA test, your specialist may prescribe certain probiotics or antibiotics to help optimise your endometrial microbial balance if deemed necessary.
The EMMA test procedure involves extracting endometrial tissue that will be sent as a sample for testing.
Analysis of Infectious Chronic Endometriosis (ALICE) Test
Chronic endometriosis is a disease that affects women of reproductive age and is commonly associated with pelvic pain and infertility. 
In this condition, the endometrial tissue is found outside the uterus, though the exact root cause remains a mystery to this day. 
The ALICE test is somewhat similar to the EMMA test. It helps detect the presence and quantity of pathogenic (harmful) bacteria in the uterine lining that could cause chronic endometriosis.
The ALICE and EMMA test procedures are performed similarly, where a small sample of your uterine lining is extracted and then sent for testing.
A fertility specialist may recommend any of these tests to those who have experienced recurrent IVF treatment failures or miscarriages.
Understandably, you may be considering these tests if you’re due to undergo fertility treatment.
In any circumstance, consulting your trusted healthcare professional would be the best route to find out whether these tests are beneficial and relevant to your personal case.