EMMA Test for IVF: Questions to Ask Your Fertility Doctor

IVF is a big step, and it’s totally normal to wonder about extra tests that might boost your chances of success. One option to consider is the EMMA test, which looks at the balance of tiny organisms in the lining of the uterus.

When that balance is off, it could be linked to problems like repeated IVF failures like trouble with implantation, or miscarriage. Asking the right questions helps you feel more in control and less overwhelmed by all the decisions ahead. And if you’re not sure what to ask, keep reading — here’s all you need to know to make the best decision for you and your (growing) family.

What is the EMMA test for IVF?

EMMA (Endometrial Microbiome Metagenomic Analysis) is a test that looks at the bacteria living in the lining of the uterus — the endometrium — where an embryo is supposed to attach and grow into a fetus. The idea is that when the mix of bacteria in this area is off balance, it might cause problems with getting or staying pregnant, especially during IVF.

Researchers have been studying how bacteria in the body affect all kinds of health issues — like chronic endometriosis — so it makes sense they’re also exploring how these tiny organisms might affect fertility. When it comes to IVF, the endometrial microbiome is a big deal. If the bacteria in your uterine lining aren’t balanced, it might mess with embryo implantation and even affect how well a pregnancy progresses.

Having lots of “good” bacteria — especially Lactobacillus — in the uterus often goes hand-in-hand with better embryo implantation. On the other hand, too much “bad” bacteria could be one reason IVF cycles don’t pan out. By checking the microbiome (from tests like EMMA), fertility doctors can create a personalized plan and might suggest probiotics or antibiotics to get your endometrial bacteria back to balance.

If you’re new to the EMMA test and you want to find out more from your doctor, here are some questions you can ask:

• How does the EMMA test fit into an IVF treatment plan? A fertility doctor can explain how the test results might guide personalized treatments, such as probiotic supplementation or antibiotic therapy.
• How reliable are the results? You can ask your fertility doctor about this, but there is more information about the accuracy of the EMMA test on the Igenomix website.
• Are there any known risks or complications? Although the EMMA test is generally considered safe, it’s worth discussing potential risks specific to you and your circumstances, especially for those who have underlying reproductive or uterine conditions.
• Does the EMMA test improve IVF success rates? Fertility tests aim to boost your odds of pregnancy by figuring out if there’s anything that can be treated, but everyone’s journey is different, and research shows a healthy endometrial microbiome can help. While bigger studies are still needed, some clinics using EMMA have seen promising results — so it’s a good idea to ask your doctor about their own experiences and success stories.
• What interventions are recommended if the results show an imbalance? Gaining clarity on treatment steps can help you feel more prepared for what’s next.

How long does an EMMA test take?

Timing is everything in IVF. Many people worry about how a new test might affect their already carefully planned schedule. Understanding the procedure and result timelines can make the process feel more manageable.

An EMMA test usually involves a brief endometrial biopsy, often performed in the latter part of a menstrual cycle (the luteal phase), around 7-10 after ovulation. This is when the lining is in a phase similar to the time it would be at embryo transfer. The biopsy itself involves collecting a small tissue sample from the uterus with a thin catheter passed through the cervix. Although it might sound intimidating, it generally causes only mild, short-lived discomfort for most individuals.

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“About 1 in 3 patients with recurrent implantation failure have a displaced WOI (window of implantation), meaning their receptive phase occurs earlier or later than expected. Adjusting transfer timing based on ERA can improve synchronization between the embryo and endometrium, thus increasing the chance of successful implantation.”

— Lauren Hurst

BA, BSN, RN, Medical Science Liaison, Igenomix

After the sample is taken, it’s sent to a specialized lab for metagenomic analysis. Results typically come back in about two to three weeks, though this may vary based on shipping, lab volume, and other practical factors. This timeline can push back an embryo transfer, especially if the doctor recommends a course of antibiotics or probiotics to balance the microbiome before going ahead with a new IVF cycle.

It’s a good idea to talk with a fertility specialist about when to schedule the biopsy and how it might affect an ongoing or planned cycle. Ask if there are any ways to streamline the IVF process and reduce delays. Because everyone’s situation differs, a doctor’s advice on scheduling and expectations can help avoid surprises.

Here are some more questions to ask about the timing of your EMMA test:

• When should the biopsy be scheduled within the cycle? Knowing the best day to schedule the EMMA test biopsy helps avoid clashes with other crucial IVF milestones.
• How long will it take to receive the results? Discuss approximate timelines to plan follow-up appointments and manage any anxiety during the waiting period — it can vary for each fertility clinic.
• Will test results impact the immediate IVF schedule? It’s helpful to clarify if a delay or additional cycle is needed before attempting an embryo transfer.

Is the EMMA test painful?

Any test involving the uterus can feel a bit nerve-racking. Pain tolerance varies from person to person, and some may worry they’ll find the procedure uncomfortable. The endometrial biopsy for the EMMA test is similar to other uterine sampling procedures. A thin catheter is passed through the cervix into the uterus to collect tissue.

Usually, an endometrial biopsy causes sensations similar to menstrual cramps. Most individuals describe it as mild to moderate cramping that eases up once the biopsy is over. In some cases, over-the-counter pain relievers like ibuprofen are recommended before the appointment, and clinics sometimes offer local anesthesia if someone is especially concerned about discomfort.

It can also help to do some gentle breathing or other relaxation techniques during the procedure. Spotting or light bleeding afterward is common, and most people can go back to their normal routine the same day.

Discussing pain management options with a fertility doctor or nurse in advance can make a big difference in feeling prepared. Some people appreciate the option of taking pain relief beforehand, while others find they can get through with relaxation techniques like deep breathing. If there are any unusual symptoms, such as heavy bleeding or significant pain after the biopsy, a quick call to the doctor’s office is always a good idea.

If you’re worried about the potential pain or discomfort of the EMMA test for IVF, here’s what you can ask your doctor:

• Is sedation or anesthesia offered for the biopsy? While not always required, some clinics may offer local anesthesia for those with sensitivity.
• What kind of pain relief is recommended beforehand? A doctor might suggest ibuprofen or another mild pain reliever to help manage cramps.
• Are there any side effects or after-effects to watch for? Spotting or light bleeding is common for a day or two following the procedure, and most people can resume daily activities immediately — but it’s worth asking to find out what they would recommend for aftercare.

Is the EMMA test worth it?

Whenever a new test or add-on is introduced during fertility treatment, the most common question is whether it’s truly necessary or beneficial. Deciding whether the EMMA test is “worth it” depends on individual situations, how many IVF cycles have already been tried, underlying reproductive health conditions, and how a person feels about adding another step (and another cost) to the process.

One advantage of the EMMA test is the way it personalizes treatment. If the results show an overgrowth of problematic bacteria, a doctor may recommend a targeted antibiotic regimen, probiotics, or other strategies to restore healthy microbial balance before attempting embryo transfer. Studies have suggested that addressing microbial imbalances can improve pregnancy outcomes. There’s no guarantee it will lead to a positive test result, but it offers valuable insight into a factor that might otherwise go overlooked.

To help you further figure out whether the EMMA test is right for you and your fertility journey, you can also ask these questions to your fertility doctor:

• Are there any lifestyle factors that influence the endometrial microbiome? Emerging research shows that everyday things like diet, stress, and even certain hygiene habits can affect the balance of microbes in the uterus. While there’s more to learn, fertility experts often recommend a balanced diet, regular exercise, good stress management, and being cautious with any products used “down there” (like douches and vaginal washes) to support overall reproductive health.
• How does the EMMA test compare to other fertility tests? EMMA focuses on the bacteria living in the uterus, while other tests, like ERA, checks if the timing is just right for embryo transfer — so they tackle different parts of the IVF puzzle. Some clinics combine both tests (especially for those with multiple failed IVF attempts) to get a more complete picture.

Is EMMA right for you and your IVF journey?

Fertility journeys can feel like they have a million moving parts (and even more questions!), and adding the EMMA test might offer useful insights into why things haven't worked out so far. For a deeper look at how it works and whether it might be a fit, head over to Igenomix’s dedicated page.

And remember: any questions you have about your fertility, your body, and your mental health are all valid — there’s no such thing as a dumb question when it comes to you.

Tassia O'Callaghan is an experienced content writer and strategist, having written about a vast range of topics from chemical regulations to parenting, for brands like Peanut App Ltd, Scary Mommy, Tally Workspace, and Fertility Mapper. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.