EMMA Endometrial Microbiome Metagenomic Analysis

A screening test to evaluate the endometrium at the microbiological level

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, which detects pathogenic bacteria that can cause chronic endometritis.

Methodology

EMMA can be performed on a small sample 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.

Why use EMMA test?

EMMA is a molecular technique that provides 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)
Patients with recurrent pregnancy loss (RPL)

*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
The tests are not 100% accurate at determining the bacterial species.

Documentation

Authors: Moreno I, Garcia-Grau I, Perez-Villaroya D, Gonzalez-Monfort M, Bahçeci M, Barrionuevo M. J, Taguchi S, Puente E, Dimattina M, Lim M. W, Meneghini G, Aubuchon M, Leondires M, Izquierdo A, Perez-Olgiati M., Chavez A., Seethram K., Bau D., Gomez C., Valbuena D, Vilella F, Simon C

Publication: Microbiome. 2022 Jan 4;10(1):1. doi: 10.1186/s40168-021-01184-w.

PMID: 34980280

Title: Evidence that the endometrial microbiota has an effect on implantation success or failure

Authors: Moreno I, Codoñer F, Vilella F, Valbuena D, Martinez-Blanch J F, Jimenez-Almazán J, Alonso R, Alamá P, Remohí J, Pellicer A, Ramon D, Simon C

Publication: Am J Obstet Gynecol. 2016 Dec;215(6):684-703. doi: 10.1016/j.ajog.2016.09.075. Epub 2016 Oct 4.

PMID: 27717732

Title: Human Microbiome Project Consortium – Structure, function and diversity of the healthy human microbiome

Authors: Human Microbiome Project Consortium

Publication: Nature. 2012 Jun 13;486(7402):207-14. doi: 10.1038/nature11234.

PMID: 22699609

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