The EMMA Test – Should You Have It?

What exactly is the EMMA test? In short, it’s a new endometrial examination from the makers of the ERA test. Let’s call it a spin-off. Does it work? Here’s a quick summary.

Remember those yoghurt ads about good and bad bacteria? The EMMA test is similar. It takes a biopsy of endometrial tissue and genetically analyses the healthy and unhealthy bacteria present. Healthy Lactobacillus bacteria is good. Pathogenic bacteria is bad. A surfeit of bad bacteria potentially reduces implantation rates.

Unlike the ERA test – which remains the more compelling endometrium analyser for IVF patients – EMMA (short for Endometrial Microbiome Metagenomic Analysis) can be carried out on non-fertility patients too. That’s because it’s not pinpointing the ideal time for an embryo transfer, as the ERA test does. It just looks at your endometrium’s microbiological conditions, its ecosystem. But given EMMA is aimed at women with recurrent implantation failure or pregnancy loss after good-quality embryos are used, it’s mainly going to be offered to fertility patients already being treated at clinics.

How does EMMA work? A biopsy is taken between day 15 and 25 of a natural cycle, or, like the ERA test, around day 19 of a medicated cycle. Analysis of the sample at the genetic level assesses the bacteria in greater detail than traditional culturing methods. If the microbial health, or flora, of your endometrium is sub-optimal, you may be prescribed antibiotics or a probiotic product. A follow-up EMMA test may also be needed.

Let’s look at the numbers. 20% of female infertility is linked to the endometrium. 30% of infertile women have pathogenic (bad) bacteria in and around their endometrium. The right bacterial balance can help implantation. A recent study looked at this issue in detail. It found a link between the bad bacteria and poorer IVF outcomes.

So should you have the EMMA test? There are other treatments directed at endometrial performance – the ERA test, the endometrial scratch, intralipid infusions and low-dose steroids. The short answer is: it’s early days for EMMA. The test can’t, for example, detect 100% of the bacteria. Nor can it check if you’re resistant to the use of antibiotics, a key remedy.

A large-scale randomized trial is needed. Until then, you should view the EMMA test as promising, but nothing more. Speak to your IVF doctor to see if it’s worth giving EMMA a try.