EMMA test

The uterine microbiome plays a key role in the success of pregnancy. The EMMA test provides valuable information about this delicate environment and allows therapy aimed at restoring optimal conditions for implantation.

EMMA test — the endometrial microbiome and its role in implantation

EMMA (Endometrial Microbiome Metagenomic Analysis) is a molecular test that studies the composition of the bacterial flora (microbiome) of the uterine mucosa. The balance between “good” and “harmful” bacteria in the endometrium is essential for the implantation of an embryo and the successful course of pregnancy.

What is the Endometrial Microbiome?

Although the uterine cavity was considered sterile for a long time, modern technologies have shown that a diverse microbial environment exists in it. In healthy women, more than 90% of the bacteria in the endometrium are from the genus Lactobacillus — the so-called “good” bacteria that create a suitable environment for implantation and protection from infections.

What does the EMMA test examine?

EMMA uses metagenomic sequencing to determine:

The general bacterial diversity;
The presence and percentage of Lactobacillus spp. ;
The presence of pathogenic and opportunistic microorganisms.

If the percentage of Lactobacillus is below 90%, this may be associated with a reduced chance of implantation and a higher risk of IVF failure.

When is the EMMA test recommended?

EMMA is useful for:

Repeated unsuccessful embryo transfers;
Unexplained sterility;
Preparation for the first transfer with the aim of maximum personalization;
Suspicion of an imbalance in the bacterial environment of the uterus.

How is it carried out?

Endometrial biopsy — performed on a specific day of the cycle, often in conjunction with tests such as ERA and ALICE.
Metagenomic sequencing — DNA is extracted and bacterial species and their proportions are analyzed.
Detailed report — contains detailed information about the microbial profile of the endometrium and recommendations.

What comes next in an unbalanced microbiome?

With deviations in the microbiome (reduced lactobacillus, the presence of pathogens), an individual approach is applied with:

Antibiotic treatment
Probiotics aimed at restoring normal flora
Re-examination if necessary before embryo transfer

What do we offer in our clinic?

At Invitro Clinic “Sofia” we perform the EMMA test in the context of personalized reproductive care. Our specialists will interpret the results and draw up the most appropriate plan to restore bacterial balance and optimal transfer.