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Head Office: Wellcare Health Clinic, Nazım Hikmet Caddesi, Omağ Sitesi, Blok F1, Dükkan 3, Aydemet Metehan, Lefkoşa Nicosia Branch: Miracle Hastanesi, Prof. Hilmi İleri Sokak No:24, Lefkoşa, Kıbrıs Kyrenia Branch: Medicalport Tunççevik Hastanesi, Kurtuluş Caddesi, Numara 70, Bellapais Yolu, Girne, Kıbrıs
What Is the Endometriome™ Test?
Endometriome® is an endometrial microbiota screening test that evaluates the distribution of microorganisms in the uterine lining.
The purpose of the test is:
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?
The endometrium is the tissue in which the embryo implants in the uterus. For this reason, a healthy endometrial environment is important for the success of natural pregnancy and assisted reproductive treatments.
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:
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.
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 is a long-lasting inflammatory condition of the uterine lining. Some patients may have no symptoms at all.
Chronic endometritis may be associated with the following conditions:
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?
The test can be used for the following purposes:
The test result can help the physician make a personalized assessment together with other clinical findings.
- ✓ 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?
The test may be considered in the following situations:
- ✓ 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?
The Endometriome test evaluates the overall structure of the endometrial microbiota and the Lactobacillus proportion. It also investigates certain microorganisms that may be associated with chronic endometritis:
- ✓ 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?
For the test, the following is taken from inside the uterus:
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.
- ✓ 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?
The sample should be 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?
The following used before sampling:
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.
- ✓ 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?
No. Molecular tests detect the genetic material of microorganisms. This does not always mean an active infection, tissue invasion or a need for treatment. Exception: if Chlamydia trachomatis, Neisseria gonorrhoeae or Mycoplasma genitalium is detected, the result should be confirmed by NAAT; the patient and partner should be treated.
Results should be evaluated together with the following findings:
Unnecessary antibiotic use should be avoided, especially when microorganisms are detected in low amounts or of uncertain clinical significance.
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?
The use of probiotics in patients with a low Lactobacillus proportion has not been proven to increase the chance of pregnancy; antibiotic treatment is considered only in chronic endometritis proven by biopsy.
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.
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?
It is stated to be approximately 15 working days after the sample reaches the laboratory.
