EMMA (NGS)The Invisible Balance Behind Successful Implantation

What Is the Endometrial Microbiome?

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

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Dr. Maria Oikonomou Obstetrician – Gynecologist

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