The importance of assessing the endometrial microbiome

The balance of bacteria in the endometrium is a key factor for successful embryo implantation. In normal conditions, in the endometrium are mainly present different bacterial species of the Lactobacillus genus. The presence of dysbiotic or pathogenic bacteria may alter the endometrial microbiome and can disrupt the uterine environment, causing implantation failure and pregnancy loss.1

Pathogenic bacteria

Pathogenic bacteria

Staphylococcus, Streptococcus, Enterococcus, Mycoplasma, Ureaplasma, Enterobacteria (Escherichia, Klebsiella), Chlamydia and Neisseria

These bacteria cause infection, which is linked to implantation failure and recurrent miscarriage

Dysbiotic bacteria

Dysbiotic bacteria

Bifidobacterium, Prevotella, Sneathia, Atopobium, Veillonella...

Microbial imbalance is linked to embryo implantation failure.

Optimal microbiome

Optimal microbiome


A balanced microbiome improves the reproductive prognosis, resulting in increased chance of pregnancy and live births Optimal.

1) Moreno et al. Am J Obstet Gynecol 2016; 215:684-703.
The chronic endometritis (CE)

The most prominent example of a pathology caused by an altered endometrial microbiota is chronic endometritis (CE). CE is characterized by the persistent inflammation of the endometrial mucosa, caused by the presence of bacterial pathogens in the uterine cavity. Because CE is usually asymptomatic and undetectable through vaginal ultrasound, it is often overlooked. The prevalence of CE in infertile patients has been estimated to be approximately 39%; it has been reported as high as 60% and 66% in patients with recurrent pregnancy loss (RPL) and repeated implantation failure (RIF), respectively. 2-3

endometrial microbiome
2) Cicinelli et al. Reprod Sci 2014; 21(5):640-7.
3) Cicinelli et al. Hum Reprod, 2015; 30(2):323-30.

test report will provide information about the overall microbial enviroment of the uterine cavity. It includes:

  • Percentage of Lactobacilli in the endometrial sample.
  • Percentages of the most represented bacteria detected in the endometrial sample.
  • Whether the endometrial microbiome is normal or abnormal.
  • Detection and percentages of specific bacteria causing CE (Enterococcus spp., Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Mycoplasma spp, and Ureaplasma spp).
  • Detection and percentages of pathogens associated with sexually transmitted infections (Chlamydia and Neisseria spp).

Endometriome test can be performed from a small endometrial biopsy or endometrial fluid.

Endometriome test can be performed between days 15 and 25 of the natural cycle, or during the uterine secretory phase in a HRT cycle.

How Endometriome™ works

A complete and accurate screening test

Endometriome procedure step by step

how it works

A new dimension of endometrial assessment that may improve your patient's reproductive outcome

Endometriome is a screening test that evaluates the endometrial microbiome, to improve clinical management of infertile patients.

Endometriome test provides a complete view of the endometrial bacterial composition, reporting the most represented bacteria in the endometrium, as well as identifying the 8 most common pathogens causing chronic endometritis (CE).

Endometriome test can determine whether the uterine microbial environment is optimal for embryo implantation. Depending on the results, the physician may recommend embryo transfer or treatment to restore an optimal microbiome.

Endometriome test also detects chronic endometritis causing bacteria and helps clinicians to recommend appropriate antibiotic and probiotic treatments.


Improve the patient's reproductive outcome

Endometriome can determine the percentage of lactobacillus present in the endometrium, to improve the patient's reproductive outcome.

Endometriome will determine whether the uterine microbial environment is optimal or not for embryo implantation.
If the endometrium is non-Lactobacillus dominated, the physician may recommend a proper treatment.

Endometriome also detects the most common pathogenic bacteria causing chronic endometritis.


test may be beneficial for



Complete endometrial microbiome profile

Endometriome test uses the latest Next Generation Sequencing (NGS) technology to determine the complete endometrial microbiome profile from endometrial tissue or endometrial fluid. It also provides information on the detection and percentage of specific bacteria causing CE.

The technology is based on DNA extraction followed by amplification and barcoded sequencing of 7 hypervariable regions (V2, V3, V4, V6, V7, V8, and V9) of the bacterial 16S ribosomal RNA (rRNA) gene 4-5 .

This bacterial gene, conserved in all bacteria, presents nine variable regions with species-specific DNA sequences. This enables the taxonomic assignment and relative quantification of each bacteria present in a sample.

4) Franasiak et al. J Assist Reprod Genet 2016;33:129–136.
5) Tao et al. Hum Microbiome J 2017;3:15–21.


advanced molecular diagnostics solutions in reproductive genetics using state-of-the art technologies

Test performed in Italy
(Rome or Milan)

Fast TAT:
10 days

20 years

Personalized genetic counseling

Laboratories ISO 17025 accredited

Test available

Over 200.000
genetic tests/year.

Dedicated R&D team


Understanding Endometriome™ results


Identification of dysbiotic or pathogenic bacteria, with a non–Lactobacillus dominated (<90%) endometrial microbiota. Detection of specific bacteria causing CE (Enterococcus spp., Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Mycoplasma spp, and Ureaplasma spp) or pathogens associated with sexually transmitted infections (Chlamydia and Neisseria spp) This test results is significantly correlated with adverse reproductive outcomes (reduced implantation rate and increased miscarriage rate).


The endometrial microbiome is normal (Lactobacillus dominated endometrium, with high percentage of Lactobacilli, ≥90%)

Endometriome Technical Report


5 easy STEPS

Order the endometriome shipping kit

Fill in all requires TRF information

Collect the sample

Ship the sample to Genoma Lab

Receive results in as little as 10 days


Information request for Endometriome test

Contact us by calling the Contact Center 06.164161500 (12 lines PBX) to discover how you can perform Endometriome test or fill out the form below. Your personal information will be used exclusively to satisfy your request, in the absolute respect of your privacy.

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