Endometrial Microbiome Metagenomic Analysis

A screening test to evaluate the endometrium at the microbiological level

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  • The endometrium was considered a sterile cavity, but recent research has identified the existence of the endometrial microbiome. 
  • EMMA reports the ten most abundant bacteria in the endometrium, to help improve clinical management of infertile patients by determining the percentage of Lactobacilli and dysbiotic bacteria.
  • Our scientific publication Evidence that the endometrial microbiota has an effect on implantation success or failure, establishes that the pathological modification of endometrial microbiota is associated with poor reproductive outcomes for IVF patients.

    Moreno et al. Am J Obstet Gynecol. 2016; 215:684-703

More info

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EMMA can be performed on a small piece of 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.


  • EMMA can determine the percentage of lactobacillus present in the endometrium, to improve the patient's reproductive prognosis.
  • EMMA indicates too 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.
  • This test can be performed in a small piece of endometrial tissue.
  • Bacteria causing Chronic Endometritis and STI
  • Enterococcus spp.
  • Streptococcus spp.
  • Staphylococcus spp.
  • Enterobacterias (Escherichia coli, Klebsiella pneumoniae)
  • Mycoplasma spp.
  • Ureaplasma spp.
  • Gardnerella vaginalis
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae


  • The impact of the endometrial microbiome in patients with Recurrent Implantation Failure (RIF) has been demonstrated.
  • 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


EMMA uses the latest Next Generation Sequencing (NGS) technology to provide microbiome information in endometrial tissue by analyzing the complete endometrial microbiome profile.

The molecular assessment of the microbiome using NGS allows to detect culturable and non-culturable bacteria.




Scientific publications and documents.

EMMA publications

EMMA publications

EMMA Specialist Brochure





EMMA Infography

Endometrial receptivity array: Clinical application.

Mahajan N.
J Hum Reprod Sci.2015 Jul-Sep;8(3):121-9. doi: 10.4103/0974-1208.165153. PMID: 26538853 [PubMed] PMCID: PMC4601169. [Epub ahead of print]

Human Endometrial Transcriptomics: Implications for Embryonic Implantation.

Gómez E, Ruíz-Alonso M, Miravet J, Simón C.
Cold Spring Harb Perspect Med. 2015 Mar 27. pii: a022996. doi: 10.1101/cshperspect.a022996. [Epub ahead of print]

The genomics of the human endometrium.

Ruiz-Alonso M, Blesa D, Simón C.
Biochim Biophys Acta. 2012 Dec;1822(12):1931-42.

Profiling the gene signature of endometrial receptivity: clinical results.

Garrido-Gómez T, Ruiz-Alonso M, Blesa D, Diaz-Gimeno P, Vilella F, Simón C.
Fertil Steril. 2013 Mar 15;99(4):1078-85.

Impact of final oocyte maturation using gonadotropin-releasing hormone agonist triggering and different luteal support protocols on endometrial gene expression.

Bermejo A, Cerrillo M, Ruiz-Alonso M, Blesa D, Simón C, Pellicer A, Garcia-Velasco JA.
Fertil Steril. 2014 Jan;101(1):138-146.e3.

The impact of using the combined oral contraceptive pill for cycle scheduling on gene expression related to endometrial receptivity.

Bermejo A, Iglesias C, Ruiz-Alonso M, Blesa D, Simón C, Pellicer A, García-Velasco J.
Hum Reprod. 2014 Jun;29(6):1271-8. doi: 10.1093/humrep/deu065. Epub 2014 Apr 4.

Clinical management of endometrial receptivity.

Blesa D, Ruiz-Alonso M, Simón C.
Semin Reprod Med. 2014 Sep;32(5):410-3. doi: 10.1055/s-0034-1376360. Epub 2014 Jun 24.

Transcriptomics of the human endometrium.

Díaz-Gimeno P, Ruíz-Alonso M, Blesa D, Simón C.
Int J Dev Biol. 2014;58(2-4):127-37. doi: 10.1387/ijdb.130340pd.

Timing the window of implantation by nucleolar channel system prevalence matches the accuracy of the endometrial receptivity analysis.

Nejat EJ, Ruiz-Alonso M, Simón C, Meier UT.
Fertil Steril. 2014 Sep 17. pii: S0015-0282(14)02025-1. doi: 10.1016/j.fertnstert.2014.07.1254.

Deciphering the proteomic signature of human endometrial receptivity

Hum Reprod. 2014 Sep;29(9):1957-67. doi: 10.1093/humrep/deu171. Epub 2014 Aug 8

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