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Genetic Solutions > Emma

EMMA Endometrial Microbiome Metagenomic Analysis

A screening test to evaluate the endometrium at the microbiological level

  • Technical Overview
  • Documentation
  • Scientific evidence
  • I’m not a health specialist

20% of infertility is caused by the endometrial factor

30%
of infertile women
have pathogenic bacteria

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Overview
  • EMMA
  • Benefits
  • Indications

What is the EMMA test?

EMMA is a test that analyses the endometrial microbiome to help identify abnormalities associated with a poor reproductive prognosis.

EMMA indicates the endometrial microbiome balance, providing information on the proportions of healthy endometrial bacteria, including those linked to higher pregnancy rates. EMMA also includes ALICE [LINK TO ALICE], which detects pathogenic bacteria that can cause chronic endometritis.

Metodology

implantation failure

EMMA can be performed on a small piece of an endometrial biopsy.

If the patient is undergoing an ERA test, a small portion of the same biopsy can be used, so no additional sample will be required

How to collect and send the sample

For EMMA, an endometrial biopsy should be taken from day 15 to day 25 of the menstrual cycle. After retrieval, it is important that the sample is briefly shaken vigorously and immediately placed in the refrigerator at 4–8°C for a minimum of 4 hours.

Why use EMMA test?

  • EMMA uses the latest Next Generation Sequencing (NGS) technology to provide endometrial microbiome information by analysing the complete profile of the microbes present in the tissue
  • EMMA can determine the percentage of Lactobacillus present in the endometrium; low proportions of Lactobacillus are associated with poor reproductive outcomes
  • The ALICE test, included with EMMA, indicates the possible presence of bacterial pathogens that can cause chronic endometritis or other diseases
  • If the endometrium is non-Lactobacillus dominated, the report will suggest the adequate treatment for each patient
  • EMMA will determine whether the uterine microbial environment is optimal or not for embryo implantation

Who should use the EMMA?

  • Patients with repeated implantation failure (RIF)
  • EMMA can be beneficial for any patient wishing to conceive, by assessing the microbiological environment that the embryo will encounter at implantation

*Moreno et al., 2016

Additional Information & Test limitations

  • Any planned uterine surgical intervention should be performed before sample collection, so that the endometrium is in suitable condition for embryo transfer
  • Some reports describe a higher prevalence of microbiota alterations in patients with endometriosis
  • If the patient has fluid in the endometrial lining, the biopsy can be taken. This liquid is most likely caused by an infection of the endometrium
  • The biopsy could be performed even if the endometrium does not have a trilaminar appearance
  • If a Dilation and Curettage takes place after EMMA or ALICE test, the results could change. We recommend repeating the test after D&C procedures, ideally in the cycle immediately before the embryo transfer.
  • We currently have no data about the effect of chemotherapy or radiation on the endometrial microbiome
  • We currently have no data about the relationship between chronic thyroiditis or polycystic ovary syndrome and the abnormal microbiota
  • Use of antibiotics can affect EMMA results and should be disclosed when requesting the test
  • Inadequate sample or sample preservation:
    • Sample not stored at 4–8°C for a minimum of 4 hours.
    • Degradation of sample due to displacement of RNAlater stabilization solution from the cryotube by a biopsy that is very large or not fully immersed in preserving agent.
    • Insufficient starting material: Not enough tissue sample. (7mm tissue is optimal)
    • Excessive blood and mucus in the biopsy sample
    • External or residual contamination
    • Exposure to excessively high temperatures

Clinical Limitations:

  • These tests are not able to detect resistance to antibiotics
    ALICE only detects the presence of pathogens associated with chronic endometritis. A negative result does not rule out the presence of other endometrial pathogens.
  • The tests are not 100% accurate at determining the bacterial species.
Documentation
  • EMMA Specialists' documents

Technical Sheets

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Brochure

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Scientific evidence

Relevant related studies:

Evidence that the endometrial microbiota has an effect on implantation success or failure. Moreno, Inmaculada et al. American Journal of Obstetrics & Gynecology, Volume 215, Issue 6, 684 – 703.

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Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature 2012; 486:207–14. 

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Igenomix and fertility

We work to make a world in which infertility is no longer an impossible barrier. Together with clinics and fertility specialists worldwide, we investigate human reproduction to change the lives of those who are trying to conceive.

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Other services you may be interested

ERA

Evaluates the endometrial receptivity

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EndomeTRIO

A new dimension of endometrial health

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ALICE

Detects the bacteria causing chronic endometritis

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