Endometrial Microbiome Testing
Endometrial microbiome testing is a modern and specialized diagnostic examination that evaluates the microbial balance inside the uterus. In recent years, scientific research has highlighted the role of the endometrial microbiome in endometrial receptivity and the embryo implantation process.
This test is not part of the standard gynecological workup, but it is used in selected cases during infertility evaluation, especially when there are repeated implantation failures or unexplained miscarriages.
What is the endometrial microbiome?
The endometrial microbiome refers to the collection of microorganisms that are normally present inside the uterus. Contrary to older beliefs, the uterus is no longer considered a sterile environment, but one that has its own microbial balance.
The predominance of certain “beneficial” bacteria appears to be associated with better endometrial receptivity, while disruption of this balance (dysbiosis) may affect the implantation process.
Uterine microbiome: How is the test performed?
Testing the endometrial microbiome is performed by obtaining a sample from the inner lining of the uterus, so that the full range of microorganisms present in the endometrium can be analyzed.
How is the sample collected?
The sample is collected using a special, very thin, sterile device that passes through the cervix into the uterus. The procedure:
- is brief and is generally performed in the doctor’s office
- can also be carried out during hysteroscopy
- does not require an incision in the body
- may be accompanied by slight discomfort but is usually not painful
The sample is processed in a specialized laboratory, where the microorganisms that make up the endometrial microbiome are analyzed. This analysis may include molecular methods, such as DNA sequencing, which provide a complete picture of the microbial community and identify possible imbalances.
Timing and results
The sample collection itself takes only a few minutes. The laboratory analysis results are usually available within a few days, depending on the laboratory’s protocol.
The doctor will explain the results and recommend the next steps if a microbial imbalance is detected.
How does the microbiome affect fertility?
Successful embryo implantation does not depend only on embryo quality or endometrial thickness, but also on the overall functional condition of the endometrial cavity. The endometrial microbiome appears to be one of the factors that influence this receptivity.
An endometrium with balanced microbial flora—where beneficial bacteria predominate—is considered a more “friendly” environment for implantation. By contrast, the presence of pathogenic microorganisms or microbial imbalance (dysbiosis) may be associated with:
- reduced implantation rates
- recurrent miscarriages
- failed IVF cycles
In some cases, disruption of the microbiome may be linked to subclinical or chronic inflammation of the endometrium, which is not always apparent on routine tests.
Uterine microbiome testing helps identify such disturbances and allows, where needed, targeted treatment before starting or repeating an assisted reproduction cycle.
What do the results show?
The results of endometrial microbiome testing provide a detailed picture of the uterus’s microbial composition and assess whether there is balanced microflora or indications of dysbiosis.
Specifically, the analysis may show:
- the percentage of “beneficial” bacteria considered favorable for endometrial receptivity
- the presence of pathogenic microorganisms
- indications of chronic or subclinical inflammation
A normal microbiome is characterized by the predominance of specific bacterial strains associated with better implantation conditions. By contrast, disruption of this balance may require a targeted therapeutic approach before a new attempt at conception or an IVF cycle.
Interpretation of the results is not based on a single number or percentage alone. The woman’s medical history, previous treatment outcomes, and the overall condition of the endometrial cavity are always taken into account.
The goal is not simply to record microorganisms, but to optimize the conditions for successful implantation and pregnancy when this is considered necessary.
Frequently Asked Questions (FAQ)
In most cases, microbiome disruption does not cause obvious symptoms. It is often identified during the investigation of infertility or failed implantation attempts.
In cases of dysbiosis, targeted treatment may be recommended depending on the findings. Management is individualized, with the aim of restoring microbial balance before the next attempt at conception.
Treatment is determined by the type of microorganisms detected. In some cases, targeted antibiotic therapy may be prescribed, while the need to test or treat the partner is assessed on an individual basis.
In cases of microbial imbalance, targeted treatment may be recommended, which may include probiotics or other interventions. Taking probiotics without medical guidance does not replace diagnostic evaluation, and effectiveness depends on the findings.
The test itself does not increase success rates. However, in selected cases of repeated failures, identifying and addressing microbial dysbiosis or chronic endometritis may improve implantation conditions before a new IVF cycle.
Sample collection is brief and performed without an incision. It may cause mild discomfort similar to menstrual cramps, but it is usually well tolerated.
The timing is determined by the treating physician, depending on the purpose of the investigation and the reproductive plan.
Endometrial microbiome testing is usually performed in specialized private laboratories and is not part of the basic insurance-covered workup. The cost depends on the type of analysis, and the doctor provides detailed information before the test is carried out.
Get a second opinion! Schedule an appointment
