What is EMMA (Endometrial Microbiome Metagenomic Analysis)?

The test is aimed to analyse the endometrial microbiome to help identify abnormalities associated with a poor reproductive prognosis.

 EMMA is a molecular tool used to determine whether the uterine microbial environment is optimal for endometrial health. This molecular method is based on detecting and measuring the amount of bacterial DNA present in the endometrial sample. 

Therefore, EMMA helps to determine when the endometrium presents a physiological bacterial flora. Lactobacilli accounts for less than 90% of the microbiotal in the endometrium which will lead to significantly decrease in pregnancy rate.

If the result comes back indicated “ ABNORMAL ENDOMETRIAL MICROBIOME” , doctors can provide appropriate probiotics suggested by the report for the patient to use in order to create a better endometrium environment for later implantation. 

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 bacteria present in the tissue

• EMMA can determine the percentage of Lactobacillus present in the endometrium; low proportions of Lactobacillus are associated with lower pregnancy rate. 

• EMMA includes the ALICE test, so it indicates the possible presence of bacteria that can cause chronic endometritis, further other pathogenic bacteria.

• 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

How is EMMA done?

Doctors will use pipelle endometrial suction curette to go into the uterus through vagina, acquire a small amount of endometrium samples. The whole procedure takes around 30 seconds to 1 minute. 

What is ALICE (Analysis of Infectious Chronic Endometritis)?

Chronic endometritis(CE)will lead to endometritis which is one of the reasons for infertility and under most circumstances patients do not appear with obvious symptoms.ALICE is  a test that detects pathogenic bacteria and recommends adequate treatment. In traditional IVF, doctors can not diagnose the bacterias  specifically, and can not prescribe the appropriate treatment. 

ALICE is a diagnostic test to detect and quantify the most common 8 pathogenic bacteria causing chronic endometritis, recommending appropriate antibiotic and probiotic treatment

• -Enterobacteria (e.g. Escherichia, Klebsiella)

• -Chlamydia

• -Mycoplasma

• -Neisseria

• -Ureaplasma

• -Enterococcus

• -Streptococcus

• -Staphylococcus

※  In cases of repeated implantation failure or recurrent pregnancy loss, chronic endometritis can rise to 66%.

Who should use ALICE?

• ALICE can be beneficial for any patient wishing to conceive, by assessing the microbiological environment that the embryo will encounter at implantation.

• ALICE may also be beneficial for patients with a history of recurrent pregnancy loss or recurrent implantation failure because chronic endometritis has been linked to these events.

How is ALICE done?