IVF - ASSESSMENT OF THE REPRODUCTIVE ENVIROMENT
Endometriome is a screening test that allows for the study of the genetic composition of the endometrial microbiota, determining whether it is represented by a physiological or pathological flora.
The Endometriome test provides a comprehensive overview of the endometrial bacterial composition, reporting the most represented microorganisms in the endometrium, as well as identifying the 13 pathogens most commonly associated with chronic endometritis.
Endometriome Plus also allows, upon specific request, to evaluate the presence of certain species of Candida (Albicans, Glabrata, Krusei, Parapsilosis, and Tropicalis) at the endometrial level. The ENDOMETRIOME® test provides useful information for planning the reproductive pathway.
For example, in infertile couples undergoing assisted reproductive technology (ART), such analysis allows for a more accurate choice of the optimal timing for the uterine transfer of embryos. Based on the test results, the specialist may advise transferring the embryo or waiting and conducting a probiotic treatment to restore the optimal microbial environment.
Microbial culture is the current reference method for evaluating the endometrial bacterial population; however, this method is not effective for the entire population under investigation, and it is estimated that a percentage of bacteria between 20% and 60% cannot be cultivated.
The molecular evaluation of the microbiome through Endometriome allows for the detection of bacteria that cannot be cultivated. Currently, the diagnosis of chronic endometritis is made through procedures such as hysteroscopy with biopsy samples on which histological examination and microbial culture are performed.
The limitations of microbial culture inevitably reflect on the diagnosis of chronic endometritis, which can be overlooked with traditional methods. Furthermore, since these classical methods are unable to identify the pathogenic agents causing the disease, they can lead to inadequate therapeutic interventions, as they are not targeted toward the specific bacterial population responsible for chronic endometritis.
ENDOMETRIOME
Available panels
Endometriome
Endometriome Plus
ENDOMETRIOME
Who it's recommended for
Endometriome is indicated in cases of:
Patients with repeated embryo implantation failures (RIF)
Patients with recurrent pregnancy loss (RPL)
Patients approaching a medically assisted procreation (MAP) pathway
All patients planning a pregnancy in the absence of specific clinical indications
ENDOMETRIOME
Analysis method
The analysis workflow includes the extraction of DNA from the biological sample, followed by DNA amplification through PCR and subsequent sequencing of the 7 hypervariable regions (V2, V3, V4, V6, V7, V8, and V9) of the bacterial 16S gene that encodes for 16S ribosomal RNA. The bacterial 16S rRNA gene, conserved in all bacteria, has nine variable regions with species-specific DNA sequences.
This allows for taxonomic assignment and relative quantification of each bacterium present in a sample. The resulting genetic sequences are analyzed through bioinformatics analysis. The bacteria responsible for chronic endometritis analyzed through sequencing include: 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.
The detection of Candida species (Albicans, Glabrata, Krusei, Parapsilosis, and Tropicalis) occurs using Real-Time technology. The presence of these microorganisms will be reported if it exceeds a specific cut-off defined for each pathogen.
Scientific publications in support
(1) Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224(3):251-257. doi:10.1016/j.ajog.2020.10.019.
(2) Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol. 2018;218(6):602.e1-602.e16. doi:10.1016/j.ajog.2018.02.012.
(3) Moreno I, Codoñer FM, Vilella F, et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016;215(6):684-703. doi:10.1016/j.ajog.2016.09.075.
(4) Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril. 2021;115(3):546-560. doi:10.1016/j.fertnstert.2020.12.010.
(5) Cicinelli E, Matteo M, Tinelli R, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014;21(5):640-647. doi:10.1177/1933719113508817.
(6) Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015;30(2):323-330. doi:10.1093/humrep/deu292.
IVF - ASSESSMENT OF THE REPRODUCTIVE ENVIROMENT