The Endometrial Microbiome Metagenomic Analysis (EMMA) is a test that helps evaluate a woman’s endometrial environment at a macrobiological level

For successful embryo implantation, the uterine microbial environment has to be in optimal conditions. Testing the microbiome can help identify and correct abnormalities that can be associated with failed implantation or miscarriages.

EMMA is a diagnostic test that indicates the endometrial microbiome balance and provides a complete profile of the bacteria present in the endometrial tissue (the lining of the womb). These bacteria include those linked to higher pregnancy rates such (Lactobacillus). It has been observed that a low proportion of Lactobacillus is associated with poor reproductive outcomes.


EMMA tests require only a small endometrial tissue that can be taken at the clinic. This is a small procedure, which requires no sedation. The sample will then be analysed using the latest Next Generation Sequencing (NGS) technology to provide a complete profile of the bacteria present in the tissue. EMMA includes the ALICE test that detects the bacteria causing chronic endometritis. Following the results, a suitable treatment can be recommended to improve your pregnancy prospects.

Who is the EMMA test recommended for?

EMMA can be beneficial for anyone who has undergone fertility treatments and has faced repeated implantation failure. It is also beneficial for all patients who wish to conceive, for a successful outcome, by assessing the microbiological environment that the embryo will encounter at implantation.

EMMA is an adjunct service and is not recommended for all patients. Please speak to your consultant about whether it might be beneficial for you.

Further Reading

Please refer to the regulator’s web page regarding treatment “add-ons” for further information: HFEA

Igenomix website:EMMA


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

Evidence that the endometrial microbiota has an effect on implantation success or failure. Moreno, Inmaculada et al. American Journal of Obstetrics & Gynecology, Volume 215, Dec 2016, Issue 6, 684 – 703.