EMMA+NGS The Invisible Balance Behind Successful Implantation

The success of a pregnancy doesn’t rely solely on the embryo. The "soil" in which it will be implanted – the endometrium – must be biologically, immunologically, and microbiologically prepared to receive it. In recent years, science has turned its attention to a critical factor: the endometrial microbiome. The EMMA (Endometrial Microbiome Metagenomic Analysis) test, in combination with NGS (Next Generation Sequencing) technology, reveals the composition of the endometrium’s microbial community – a microscopic world that may determine implantation success.

What Is the Endometrial Microbiome?

It is the natural community of microorganisms (mainly bacteria) that live in the endometrium. Just like the gut and vagina, the inside of the uterus also hosts a microbiome, and the balance of this micro-ecosystem has proven critical for embryo receptivity.

A healthy uterus is characterized by the dominance of Lactobacillus, a beneficial
bacterium that regulates pH, prevents overgrowth of harmful organisms, and enhances endometrial receptivity. When this balance is disturbed, the environment becomes inflammatory, non-receptive, and the risk of implantation failure or miscarriage increases.

When the EMMA + NGS Test Is Recommended

The test is indicated when:

There are repeated implantation failures (RIF) without a clear cause

Chronic endometritis or previous infections have been diagnosed

There are previous unexplained miscarriages

Before the first IVF attempt, in women with a risk profile or history of dysbiosis

How Microbial Imbalance Is Treated

If microbiome imbalance is detected (low Lactobacillus percentage or increased pathogens), the treatment plan includes:

Antibiotic therapy

Probiotic supplements to restore Lactobacillus

Monitoring and re-evaluation

Restoring microbial balance has been shown to improve endometrial receptivity, increasing the chances of implantation and healthy pregnancy. At FertUlity, we don’t stop at diagnosis — we invest in ongoing monitoring and restoration of microbial balance. We create personalized treatment plans based on the EMMA test results and work closely with our patients to restore a healthy endometrial environment before starting the next IVF cycle — to lay the proper foundation for a successful pregnancy.

Frequently Asked Questions About EMMA Test

Does the EMMA test hurt?

The EMMA test is completely safe and based on an endometrial biopsy, a short and relatively painless procedure similar to a Pap smear, performed without anesthesia.

Should it be done in every IVF cycle?

No. The EMMA test does not need to be repeated in every IVF cycle. Once the microbiome is assessed and its balance restored, repeat testing is unnecessary unless new signs of disturbance or relapse appear.

What does an abnormal result mean?

An abnormal result indicates that your microbiome is not dominated by Lactobacillus, which may hinder successful implantation. It’s not a reason to worry — it’s a marker that can and should be corrected.

How do the EMMA and ALICE tests differ?

EMMA focuses on analyzing the overall balance and presence of beneficial bacteria (mainly Lactobacillus). ALICE detects pathogens that cause inflammation. The combination of the two tests provides a complete picture of endometrial health.

Can it improve implantation success rates?

Yes! Proper microbial balance is associated with significantly higher implantation success rates and reduced miscarriages, 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. Maria Oikonomou Obstetrician – Gynecologist

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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