What Is the Endometriome™ Test?
The purpose of the test is:
- ✓ To determine the proportion of beneficial bacteria in the endometrium, particularly Lactobacillus species,
- ✓ To investigate microorganisms that may be associated with chronic endometritis,
- ✓ To evaluate microbial imbalances that may affect embryo implantation in the uterus.
Why Is the Endometrial Microbiota Important?
An environment in which Lactobacillus species predominate and no disease-causing microorganisms are present is considered more favorable for embryo implantation.
On the other hand:
- ✓ A decrease in the proportion of Lactobacillus,
- ✓ Disruption of the microbial balance,
- ✓ The presence of microorganisms associated with chronic endometritis
can adversely affect the intrauterine environment. However, this test alone does not explain the cause of infertility and does not guarantee the success of a pregnancy.
What Is Chronic Endometritis?
Chronic endometritis may be associated with the following conditions:
- ✓ Recurrent implantation failure,
- ✓ Recurrent pregnancy loss,
- ✓ Unexplained infertility,
- ✓ Failure of assisted reproductive treatments.
Why Is It Performed?
- ✓ To identify endometrial microbiota imbalance at an early stage,
- ✓ To evaluate the Lactobacillus proportion,
- ✓ To investigate microorganisms associated with chronic endometritis,
- ✓ To help plan treatment according to the intrauterine microbial profile,
- ✓ To provide additional information about the endometrial environment before IVF treatment.
The test result can help the physician make a personalized assessment together with other clinical findings.
Who Is It Recommended For?
- ✓ Those who have experienced recurrent embryo implantation failure,
- ✓ Those with recurrent pregnancy loss,
- ✓ Patients planning or undergoing IVF treatment,
- ✓ Those with unexplained infertility,
- ✓ Those with suspected chronic endometritis,
- ✓ Those who have experienced failure in previous reproductive treatments.
Which Microorganisms Does It Investigate?
- ✓ Escherichia coli
- ✓ Klebsiella species
- ✓ Chlamydia species
- ✓ Mycoplasma species
- ✓ Neisseria species
- ✓ Ureaplasma species
- ✓ Enterococcus faecalis
- ✓ Enterococcus faecium
- ✓ Streptococcus species
- ✓ Staphylococcus species
- ✓ Gardnerella vaginalis
- ✓ Pseudomonas aeruginosa
- ✓ Candida species
Endometriome®
- Escherichia coli, Klebsiella spp., Chlamydia spp., Mycoplasma spp., Neisseria spp., Ureaplasma spp., Enterococcus faecalis, Enterococcus faecium, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis and Pseudomonas aeruginosa
Endometriome® Plus
- Escherichia coli, Klebsiella spp., Chlamydia spp., Mycoplasma spp., Neisseria spp., Ureaplasma spp., Enterococcus faecalis, Enterococcus faecium, Streptococcus spp., Staphylococcus spp., Gardnerella vaginalis and Pseudomonas aeruginosa
- Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, Candida tropicalis
How Is It Performed?
- ✓ An endometrial tissue sample or
- ✓ An endometrial fluid sample
The sample is collected by an obstetrician-gynecologist using the special device included in the test kit. It is then sent to the laboratory and analyzed by DNA isolation and Next-Generation Sequencing.
When Is the Sample Collected?
- ✓ Between days 15 and 25 of a natural menstrual cycle,
- ✓ During the secretory phase in patients receiving hormone replacement therapy.
What Should Be Considered Before the Test?
- ✓ Antibiotics,
- ✓ Vaginal probiotics,
- ✓ Antifungal medications,
- ✓ Vaginal suppositories or creams,
- ✓ Hormone therapies
must be reported to the physician.
Recently used antimicrobial treatments may affect the microbiota result. Therefore, patients should not decide on their own whether to stop their medications; the sampling time should be determined by the physician.
If there is active vaginal bleeding, suspected pelvic infection or a possibility of pregnancy, the physician must be informed before the procedure.
How Are the Results Interpreted?
Lactobacillus-dominant endometrial microbiota
- Lactobacillus species are predominant.
- The Lactobacillus proportion is 90% or above.
- No microorganisms associated with chronic endometritis are detected.
- This result reflects a microbial profile that has been associated with better implantation outcomes in some studies; however, the 90% threshold is derived from research, is not a validated reference value, and does not predict pregnancy success.
Non-Lactobacillus-dominant microbiota with no pathogens detected
- The Lactobacillus proportion is below 90%.
- No microorganisms associated with chronic endometritis are detected.
- This may be consistent with endometrial microbiota imbalance. Whether treatment is needed should be assessed together with the patient's clinical condition and other findings.
Non-Lactobacillus-dominant microbiota with pathogens detected
- The Lactobacillus proportion is below 90%.
- One or more microorganisms associated with chronic endometritis are detected.
- In this case, if the physician considers it appropriate, targeted additional evaluation or treatment may be planned.
Does a Positive Result Always Mean Infection?
Results should be evaluated together with the following findings:
- ✓ The patient's complaints,
- ✓ Gynecological examination,
- ✓ Ultrasound findings,
- ✓ Histopathological examination,
- ✓ CD138 staining, if necessary,
- ✓ Culture or additional molecular tests,
- ✓ Previous infertility and treatment history.
Unnecessary antibiotic use should be avoided, especially when microorganisms are detected in low amounts or of uncertain clinical significance.
How Is Treatment Determined?
However, treatment should not be started based on the test result alone. The type and duration of the medication to be used and the need for a follow-up test should be determined by an obstetrician-gynecologist.
How Long Do Results Take?
About Endometriome
Frequently Asked Questions
What is the Endometriome test, and what is it used for?
Endometriome® is a molecular microbiome test that examines the distribution of bacteria in the inner lining of the uterus (endometrium). In particular, it investigates the proportion of Lactobacillus bacteria and microorganisms that may be associated with chronic endometritis. It may provide additional information about the microbial environment within the uterus in women who have difficulty conceiving or are undergoing IVF treatment.
Why does an embryo fail to implant in the uterus? Can the Endometriome test help?
Possible reasons for an embryo failing to implant in the uterus include the embryo's chromosomal makeup, problems within the uterus, hormonal factors and certain endometrial conditions. The Endometriome test may provide additional information for this investigation by assessing the bacterial balance within the uterus. However, it cannot determine the cause of implantation failure on its own, and performing the test has not been proven to increase the chances of pregnancy.
What is chronic endometritis, and can it prevent pregnancy?
Chronic endometritis is a persistent inflammatory condition of the inner lining of the uterus. It may sometimes develop without any symptoms. Some studies have associated it with recurrent pregnancy loss and embryo implantation failure. Endometriome investigates associated microorganisms; however, it cannot provide a definitive diagnosis of chronic endometritis on its own. An endometrial biopsy and histopathological examination may be required for diagnosis.
What is the difference between Endometriome and Endometriome Plus?
Endometriome assesses the overall composition of the bacterial microbiome within the uterus and microorganisms associated with chronic endometritis. In addition, Endometriome Plus can also investigate fungal species such as Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis and Candida tropicalis. The appropriate panel is determined based on the patient's clinical assessment.
How is the Endometriome test performed? Is it painful?
For the test, an obstetrician-gynaecologist collects an endometrial tissue or fluid sample from inside the uterus. Brief discomfort similar to menstrual cramps may be felt during sample collection. The sample is analysed using molecular methods at the Eurofins Genoma laboratory. The sampling method and preparation before the procedure are determined by the obstetrician-gynaecologist.
On which day of the menstrual cycle is the Endometriome test performed?
In a natural menstrual cycle, sampling is generally scheduled between days 15–25. For patients receiving hormone treatment, the appropriate timing may differ. The doctor decides on the most suitable sampling day, taking into account menstrual irregularities, medications being used and the IVF treatment protocol.
How long does it take to receive Endometriome test results?
The turnaround time for the Endometriome test is approximately 15 working days after the sample arrives at the laboratory. Sample collection, transport or the need for additional analysis may affect the total time. You can contact Wellcare Laboratories for the current turnaround time.
Are antibiotics needed if the Endometriome result shows a bacterial imbalance?
Not every microbiome imbalance indicates an infection. A low proportion of Lactobacillus or the detection of certain bacteria in the test does not, on its own, require antibiotic treatment. Results should be assessed alongside a clinical examination, symptoms and additional tests when necessary. The doctor decides whether antibiotic or probiotic treatment is needed.
Should everyone have an Endometriome test before IVF?
No. Endometriome is not routinely recommended for every IVF patient. A doctor may consider it for some patients with recurrent embryo implantation failure, pregnancy losses or suspected infection within the uterus. Current scientific guidelines state that there is insufficient evidence to support the routine use of uterine microbiome testing.
Where is the Endometriome test available in Cyprus, and how much does it cost?
The Endometriome test is offered in Northern Cyprus through Wellcare Laboratories in collaboration with Eurofins Genoma. You can obtain information about the sampling process from Wellcare centres in Nicosia and Kyrenia. The price of the test may vary depending on whether the Endometriome or Endometriome Plus panel is selected. You can contact Wellcare Laboratories for current pricing and appointment information.