The success of a pregnancy does not depend solely on the embryo. The “environment” in which it will implant, the endometrium, must be biologically, immunologically, and microbiologically prepared to receive it. In recent years, scientific research has focused on a critical factor: the endometrial microbiome.
The EMMA test (Endometrial Microbiome Metagenomic Analysis), using NGS (Next Generation Sequencing) technology, reveals the composition of the microbial population of the endometrium a microscopic ecosystem that can determine the success of implantation.
The endometrial microbiome refers to the natural population of microorganisms (mainly bacteria) that reside in the endometrium. Just like the gut and the vagina, the uterine environment hosts its own microbiome, and the balance of this ecosystem plays a crucial role in embryo implantation.
A healthy uterine microbiota is characterized by the dominance of Lactobacillus, a beneficial bacterium that regulates pH, prevents the overgrowth of pathogens, and enhances endometrial receptivity. When this balance is disrupted, the environment becomes inflammatory and less receptive, increasing the risk of implantation failure or miscarriage.
How the EMMA (NGS) Test Works
The test is performed through an endometrial biopsy, from which genetic material is extracted and analyzed using Next Generation Sequencing (NGS) technology.
The EMMA test can reveal:
The percentage of Lactobacillus bacteria and whether it is sufficient for normal endometrial function
The presence of potentially pathogenic microorganisms
The overall diversity of the microbiome
Signs of microbial dysbiosis, indicating disruption of the normal microbiome balance that may require intervention
The test is often combined with ALICE, which detects pathogens associated with chronic endometritis, providing a comprehensive evaluation of endometrial health.
When Is the EMMA (NGS) Test Recommended?
The test is indicated when:
There are recurrent implantation failures (RIF) without an obvious cause
Chronic endometritis or previous infections have been diagnosed
There is a history of unexplained miscarriages
Before the first IVF cycle, especially in women with risk factors or a history of dysbiosis
How Is Microbial Imbalance Treated?
If a microbiome imbalance is identified (low Lactobacillus levels or increased pathogens), the treatment plan may include:
Probiotic supplements to restore Lactobacillus levels
Antibiotic therapy (when necessary)
Monitoring and follow-up testing
Restoring microbial balance has been shown to improve endometrial receptivity, increasing the chances of implantation and a healthy pregnancy.
At FertUlity, we go beyond diagnosis by focusing on continuous monitoring and restoration of the endometrial microbiome balance. We develop personalized treatment plans based on EMMA test results and work closely with our patients to restore a healthy uterine environment before embryo transfer, creating the optimal conditions for a successful pregnancy.
Frequently Asked Questions About EMMA Test
Does the EMMA test hurt?
The EMMA test is a completely safe procedure based on an endometrial biopsy, which is a short and relatively painless process, similar to a Pap test, and is performed without anesthesia.
Should it be done in every IVF cycle?
No. The EMMA test does not need to be performed in every IVF cycle, as once the microbiome has been assessed and its balance restored, repetition is not necessary unless new indications of imbalance or recurrence arise.
What does an abnormal result mean?
An abnormal result indicates that your microbiome is not dominated by Lactobacillus, which may hinder successful implantation. It is not a cause for concern, but rather an indicator that can and should be corrected.
How do the EMMA and ALICE tests differ?
The EMMA test focuses on evaluating the overall microbiome balance and the presence of beneficial bacteria (mainly Lactobacillus). The ALICE test detects pathogens that cause inflammation. The combination of both diagnostic tests provides a comprehensive view of endometrial health.
Can it improve implantation success rates?
Yes. A balanced microbiome is associated with significantly higher implantation success rates and reduced miscarriage risk, especially in women with a history of unexplained failed IVF cycles.
Our Doctors
In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.
Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I
100% genuine, public Google reviews. Because every fertility journey begins with honesty and trust.
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Μαρια
26 days ago
The word "thank you" to Dr. Makis Papadopoulos is too small to describe the gratitude we feel for this man. I am pregnant after IVF, having succeeded on the first attempt, and we owe this exclusively to our doctor. First Contact & Communication: From the very first contact, he won us over with his kindness, enthusiasm and willingness to dedicate as much time as we needed. Willing to explain everything in every detail, he solved every question we had in depth — not even a professor to students would analyze them with such patience and contagiousness! Scientific Training: He is an excellent scientist, with deep knowledge of the subject, a perfectionist and focused professional who leaves absolutely nothing to chance. He designed the right treatment for us, solving every problem down to the last detail, making us feel that whatever problem arises, it is certain that it will be solved. HUMANITY & SUPPORT: The most important thing, however, is his humanity. Communication with him was Immediate and he always had as much time as you needed on the phone to solve every question. He showed a deep, real interest, embracing us not just as a doctor, but as if he were our brother. We highly recommend him to every couple starting this journey. He deserves blind trust! We thank you from the bottom of our hearts for the greatest miracle of our lives!
I don't often write reviews, but I feel that Mr. Makis truly deserves it. From the very first moment, he made me feel safe and confident. He listened carefully to what was on my mind, answered every question I had, and explained everything in a simple way, always based on scientific data. Many times, he even sent me relevant scientific studies so that I could better understand why he was suggesting a particular approach. But what stood out to me the most was that he didn't stop at the appointment. He followed up, was genuinely interested in my progress, and was available when I needed him. This is something you rarely encounter. Fortunately, he returned to Greece. He is one of the few doctors who, beyond their knowledge, remain above all human beings. He makes you feel like he sees you as a person and not as just another incident.
A big thank you to Dr. Makis Papadopoulos who supported us from day one, who checked every little detail, who explained to us every move-step, every test, every medication for the reason we were doing it and what we would achieve. With incredible experience, knowledge, a lot of patience (because we had two other failed attempts with another doctor) and trust, within 8 months he adapted the protocols for our case and we achieved the positive result and we hold in our arms a priceless diamond. Above all, a rare person, calm and always available to listen to our concerns and reassure us. I highly recommend him!
Thanks to Dr Makis Papadopoulos, I am now holding my two beautiful babies in my arms! He is a true expert. Professional with a human centric approach, friendly and empathetic, always available to answer our (many many) questions. I trust Dr Makis blindly and, honestly, I cannot recommend him enough!
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Ivy
100 days ago
My experience with Dr. Makis took me from a clinical stagnation to an incredible breakthrough, highly recommend Dr. Makis! Navigating the exhausting world of IVF, you know how devastating it is to watch your protocol dosages go up while your results go down. After three intense, high-dosage cycles with a previous clinic, I was left feeling incredibly discouraged. Despite escalating medications and growth hormones, my blastocyst yield was dwindling, culminating in a heartbreaking round with zero blastocysts. I knew I needed a doctor who didn't just follow a standard script, but who truly understood the nuances of egg quality and customized protocols. That is when I found Dr. Makis. Dr. Makis completely revolutionized my treatment plan. Instead of just pushing maximum dosages, he took a highly strategic, tailored approach. The result? Quality over pure protocol size. While my previous doctors kept increasing the medication dosages (which yielded fewer or zero blastocysts), Dr. Makis completely changed the strategy. He lowered the heavy stimulation, introduced smart egg-quality support (like melatonin), changed the protocol style entirely, and achieved a 700% increase in blastocysts compared to my best previous rounds. Beyond the incredible results, Dr. Makis brings a level of expertise, precision, and reassuring care that is rare to find. He looks at you as an individual, not a statistic, and knows exactly how to pivot when traditional routes fail. If you are looking for a specialist who can turn a difficult prognosis into an overwhelming success, look no further than Dr. Makis. I am incredibly grateful for his care.
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Olga
111 days ago
Dr. Makis Papadopoulos was excellent, professional, and very reassuring throughout the entire process. Thanks to his expertise and guidance, we were able to identify the issue early and take the appropriate steps from the beginning. He took the time to explain everything clearly, answered all our questions with patience, and made us feel comfortable and confident throughout our journey. We truly appreciated his caring approach, professionalism, and dedication. Highly recommended!
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Euaggelia
122 days ago
Dr. Makis Papadopoulos is an excellent scientist and above all a rare person! He is an approachable and smiling doctor, with excellent medical knowledge, who from the first moment I met him made me feel comfortable and trust him completely, answering every question I had with patience and documenting every answer with scientific studies and articles! The most important thing, however, is that Dr. Makis Papadopoulos is always there on the other end of the line to listen to you and reassure you without a trace of haste, a doctor who truly cares and makes you feel like he is your own person! Makis, thank you very much for everything!!! I am very lucky to have met you!
Dr. Makis Papadopoulos is an excellent scientist with a human-centered interest. Our collaboration was excellent from the very beginning and he made me feel confident and secure by explaining every step of the process in great detail. I highly recommend him!
Dr Makis Papadopoulos is very professional, caring and attentive. Very thorough in explaining the whole process throughout every step. Thank you! Highly recommended!!
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Christina
134 days ago
I would like to share my experience with Dr. Makis Papadopoulos, an outstanding gynecologist and scientist. We first connected in the summer of 2024, while he was based in Germany, through a mutual acquaintance, following a particularly challenging period for us. Prior to meeting him, we had gone through repeated unsuccessful attempts of stimulation and fertilization with other gynecologists. Unfortunately, those approaches relied largely on standardized protocols, without sufficient personalization to address the specific needs of my case. From the very beginning, Dr. Makis stood out for his human-centered approach and his willingness to dedicate time to truly understand our situation in depth. With strong, up-to-date scientific knowledge, he approaches every case holistically, focusing on individualized treatment and adapting protocols to the patient's unique needs. Throughout our collaboration, which now spans approximately two years (with a few breaks on our side), he has consistently been available, supportive, and clear in his guidance. He inspired confidence and helped us stay positive even during difficult phases of the journey. Beyond his scientific expertise, what truly sets him apart is his genuine care for the person behind each case: his empathy, honesty, and continuous effort to achieve the best possible outcome. My husband and I are deeply grateful for his support and guidance, and we now feel ready and optimistic to move forward to the next final stage. We highly recommend him to anyone seeking a gynecologist with true expertise, professionalism, and compassion. I would like to share my experience with Dr. Makis Papadopoulos, an excellent gynecologist and scientist. We met in the summer of 2024, when he was in Germany, through a mutual acquaintance, after a particularly demanding period for us. Before meeting him, we had gone through repeated failed attempts at stimulation and fertilization with other gynecologists. Unfortunately, the approaches that had been followed were mainly based on standardized protocols, without the necessary individualization to the specifics of my case. From the beginning, Dr. Makis stood out for his human approach and his willingness to spend time to understand our case in depth. With modern knowledge and scientific training, he approaches each issue multidimensionally, emphasizing the individualization of treatment and adapting the protocols to the real needs of the patient. During our collaboration, which now spans about two years (with short breaks on our part), he was always available, supportive and clear in his guidance. He inspired confidence in us and helped us remain optimistic even in difficult phases. In addition to his scientific competence, what sets him apart is his genuine interest in the person behind each case: his empathy, his honesty and his constant effort to achieve the best possible outcome. My husband and I thank him warmly for his support and guidance and we now feel ready and optimistic to move on to the next final stage. We highly recommend him to anyone looking for a gynecologist with real knowledge, professionalism and humanity.
Dr. Makis Papadopoulos is an excellent gynecologist and above all an excellent person! I truly thank him for his support and care during the egg freezing process. Although my case was particularly demanding, he stood by me with patience, knowledge, great experience and real interest. Our communication was direct and human, while his availability at the many appointments made me feel safe at every step. The protocols were designed specifically for me, aiming for the best possible result, while also taking into account the cost of the medications. I recommend him with all my heart to every woman who wants to trust someone for something so important and sensitive for her.
I highly recommend Dr. Makis, he is an incredible specialist. My journey was far from easy, encountering several challenges that made the process feel overwhelming at times. What sets him apart is his willingness to go beyond standard procedures. He developed a specialized, custom protocol, tailored to my situation, which ultimately made all the difference. Beyond his technical expertise, his calm and clear communication kept me grounded throughout the process. I am so grateful for his persistence and high level of care!
Why choose FertUlity?
Because every fertility journey deserves the right support. At FertUlity, we provide science-based fertility care with a human approach. We support every path, from fertility assessment and preservation to modern assisted reproduction.
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Knowledge brings confidence. At FertUlity, we share evidence-based information so you can make the right decisions about your fertility.