EMMA Endometrial Microbiome Test in London

The EMMA test is £890. On top of that, a gynaecology consultation with our team is required before any endometrial test can be arranged, and that is £300, charged separately. The two together come to £1,190, but we quote them separately because they are separate things — you can have the consultation without going on to have the test, and a good number of people do exactly that.

The £890 covers the endometrial biopsy taken in clinic, the Igenomix laboratory analysis including the ALICE chronic endometritis component, and your gynaecologist going through the report with you afterwards.

You cannot book the test on its own; there is no route to it that does not go through the consultation. Book the £300 gynaecology consultation, or see the full fees list.

Yes. ALICE — Analysis of Infectious Chronic Endometritis — is included in EMMA at no extra cost, and both analyses run on the same sample.

That matters financially. ALICE on its own is £665, so if you want both analyses, EMMA at £890 is the sensible order. If chronic endometritis is genuinely the only question you have, ALICE alone is the cheaper route, and your gynaecologist will tell you so.

If your clinician also wants the timing of your implantation window assessed, EndomeTRIO bundles EMMA, ALICE and ERA into one package — though it inherits ERA’s red HFEA rating, which is worth reading about before you choose it.

No. EMMA does not appear on the HFEA’s traffic-light list of treatment add-ons at all, which makes it unrated rather than approved.

It is worth being clear about what that does and does not mean. The HFEA rates “endometrial receptivity testing” red, and that red rating applies to ERA and to EndomeTRIO because EndomeTRIO contains ERA. Endometrial microbiome testing is simply not on the list, so there is no independent regulatory assessment of it for you to read.

Separately, ESHRE’s 2023 good practice recommendations on recurrent implantation failure state that uterine and vaginal microbiome profiling is not recommended, while assessment for chronic endometritis can be considered. We would rather you knew both of those things before you paid than after.

Suggestive, but not strong, and not the kind of evidence that would allow anyone to promise you a better outcome.

The largest study is a multicentre prospective observational study of 342 infertile patients published in Microbiome in 2022, which found that a dysbiotic endometrial profile was associated with unsuccessful outcomes and that Lactobacillus was enriched in patients who had a live birth.

The study the test was originally built on, published in the American Journal of Obstetrics and Gynecology in 2016, was a case-control comparison of just 35 patients. The difference in live birth rates it reported is widely quoted and looks dramatic, but it comes from arms small enough that a single birth either way would shift it substantially.

We set those figures out in full, with their limitations, in the evidence section above.

Both are observational. Neither randomised anyone, so neither can show that acting on the result changes what happens next. That is a genuinely different standard of proof from the randomised trial that tested ERA in 767 patients and found no significant difference in live birth rate.

It is an outpatient biopsy. A fine, flexible catheter is passed through the cervix and a small sample of the womb lining is drawn up. The procedure takes a few minutes and you go home straight afterwards.

Most people describe it as strong period-type cramping for a short time rather than sharp pain. Taking ibuprofen or paracetamol an hour or two beforehand genuinely helps. Light spotting for a day or two afterwards is normal.

If you have had a difficult cervix, a painful procedure in the past, or you are simply anxious about it, tell us at the consultation. The experience is similar to an endometrial scratch or an outpatient hysteroscopy, and we can plan around it.

At a defined point — and getting it wrong wastes the test. In a natural cycle the sample is taken in the mid-luteal phase, around the time the endometrium would be receptive. In a hormone-replacement cycle it is taken after a specified number of days of progesterone.

Your gynaecologist works the exact date out with you at the consultation, using your cycle length, any monitoring you are already having and the protocol your fertility clinic follows. If you are having follicle tracking or endometrial lining scans with us, that makes the timing straightforward.

You should not be taking antibiotics in the weeks beforehand, and local vaginal treatments and probiotics need to stop as well, because all of them change what the laboratory sees. We give you the full list in advance.

It means that in the sample analysed, most of the bacterial signal was Lactobacillus. The convention used in the research behind the test is a threshold of around 90 per cent.

What it does not mean is that your next transfer will work. Lactobacillus dominance has been associated with better outcomes in cohort studies, but transfers fail in plenty of women with entirely Lactobacillus-dominant linings. A dominant result removes one hypothesis from the list; it does not provide a guarantee.

It is also worth knowing that there is no internationally agreed definition of a healthy endometrial microbiome. The 90 per cent figure is a research convention, and different laboratories using different methods have used different cut-offs.

You have a conversation with your gynaecologist, and what follows depends on what was actually found. If ALICE has identified organisms associated with chronic endometritis, a targeted course of antibiotics may be considered. If the finding is simply a low proportion of Lactobacillus without a specific pathogen, probiotics are sometimes suggested. Doing nothing is also a legitimate option, and sometimes the right one.

We will not tell you that any of these improves your chance of a baby, because the trials that would justify that claim have not been done. The pooled evidence on antibiotics for chronic endometritis is observational rather than randomised, and in the 2018 meta-analysis listed in our sources, women treated without a repeat biopsy confirming the inflammation had cleared did no better than untreated controls.

Antibiotics also carry real costs — side effects, disruption of your other bacterial populations, and the general problem of repeat courses. Weighing that against an uncertain benefit is precisely what the consultation is for.

They answer different questions from the same sample. EMMA describes the overall bacterial balance of the lining — how much Lactobacillus, how much of everything else. ALICE looks specifically for the bacteria most often implicated in chronic endometritis.

Because EMMA includes ALICE, one test gives you both. Buying ALICE separately only makes sense if chronic endometritis is the only thing you want to know about, and it is £665 rather than £890.

Neither is the same as the traditional diagnosis of chronic endometritis, which a pathologist makes by finding plasma cells in a biopsy under the microscope. Molecular detection of bacterial DNA and histological diagnosis do not always agree, and where the histological answer is what matters, a directed biopsy at hysteroscopy may be more useful.

No. Every endometrial test we offer requires a gynaecology consultation with our team first, and there is no way around it.

This is not an upsell. The sample has to be timed to your cycle, there is a list of medications and vaginal preparations that must be stopped beforehand, someone has to decide the test is appropriate for you at all, and someone has to interpret the report afterwards. None of that works without a clinician who knows your history.

The consultation is £300 and the test is £890 on top. If the consultation concludes that EMMA would not help you, you will have spent £300 and saved £890. You can book a gynaecology consultation here, or read the full fees list first.

Not in the way the name suggests. “Metagenomic analysis” implies broad sequencing of the whole microbial community, and the original research behind endometrial microbiome testing did use 16S rRNA gene sequencing.

The commercial EMMA test Igenomix runs today uses real-time PCR against a defined panel of reproductive-tract bacteria. It measures how much of each listed organism is present rather than discovering what is there from scratch.

The practical consequence is that anything outside that panel is not reported. Igenomix states that a negative result does not exclude other endometrial pathogens, and that the test does not detect antibiotic resistance.

In most cases yes. EMMA is a standard Igenomix test and the report is the same report wherever the sample was taken. We send it to you and, with your permission, directly to your fertility clinic.

It is worth checking with your clinic before you book, though, particularly if you are being treated abroad. Some clinics have a preferred laboratory, or want the sample taken within a specific protocol cycle, and that is far easier to confirm in advance than to discover after a biopsy.

We work regularly with fertility clinics in the UK and overseas and are happy to speak to your team about what they need. See IVF pregnancy monitoring for the scanning side of that relationship.

Turnaround depends on the laboratory, and we would rather give you a realistic figure when your sample is taken than publish a number we cannot control. In practice it usually runs to a few weeks rather than a few days, because the sample travels to the Igenomix laboratory and the analysis is batched.

Occasionally a sample is inadequate and needs repeating, which adds a cycle. Your gynaecologist will explain what that means for your transfer timing if it happens.

We contact you once the report has been reviewed and go through it with you, rather than emailing a set of percentages without any context.

For most people, probably not — and we would rather say that than sell you something. If you have not yet had the standard investigations, or you have had a single failed transfer, the honest answer is that your money is better spent elsewhere for now.

Where it can be worth considering is a narrower situation: repeated failed transfers of good embryos, or recurrent loss, where structural and hormonal causes have already been examined and chronic endometritis has not been excluded. Even then, the result may not change what you do.

The most useful thing we can offer is the conversation. Book the £300 gynaecology consultation, bring your history and your previous cycle records, and let a consultant tell you whether this test has anything to add for you. Sometimes it does. Often it does not, and you should hear that from a clinician rather than from a price list.