EMMA test result - any good news stories

[CurlyJ21]

I had my results back from my EMMA test last week and they’ve found that I have 6% lactobacillus (when it ideally should be over 90%). Finally, I might have an answer for our issues as, up until now, we’ve been ‘unexplained’.

I’ve started a course of antibiotics (co-amoxiclav) in the hope that will help but after doing some reading I can’t find any/many positive outcomes after treatment. Hoping for some advice/positivity/positive news stories as, after three years of ttc (inc two miscarriages and two failed transfers), it just feels like one knock after another and I’m struggling to see the light at the end of the tunnel!

Hi @CurlyJ21 no stories just camaraderie. I’m considering doing emma after 3 failed fets of 5 day blasts. Would be interested to hear more. Sending you hugs. It is so shit.

Hi @Angliski so sorry about your failed FETs. I really is so shit!

I’m glad I did the Emma etc as I always think it’s useful to have more information but there doesn’t seem to be a lot of info out there on how helpful the treatment is.

Hi, I had 2 failed transfers. Our main cause of male factor infertility however, I did the ERA/EMMA/ALICE and I had 0% good bacteria. I took a course of antibiotics and then a month or so of probiotics and then redid it. My good bacteria went up to 75% so I kept going ahead with probiotics and did a FET which worked. Early days but first time in 4 years seeing a positive test.

I did take the probiotics (canesflor) more than recommended - they say 7 days in a row then 1 per week. I took them 14 days in a row then every second day and for around 5 days in a row in run up to FET. I also took an oral probiotic every day.

I should say it wasn’t the only thing I did before transfer. I also did natural killer cells testing so I’m on low dose steroids and I also found I had low progesterone so I was closely monitored and I’m on progesterone injections in oil too.

Following as I'm due my EMMA results soon. We are unexplained. I will update if I learn anything useful

Hi @Dochas1211 congratulations on your pregnancy! I think I’ll adopt your approach with the probiotics when I stop the antibiotics. You’ve given me some hope 😊

I also have raised NK cells so will be on low steroids too. I hope you’re coping ok with them. Physically, they are the worst part of IVF for me

@bmachine good luck for your results

Hi @CurlyJ21 are you going to repeat the test? Unfortunately my story is less positive than @Dochas1211

I had 0.00% lactobacillus, I imagine than our microflora is similar because I was also advised to take co-amoxiclav, can you upload an image of the various types of bacteria they found with the percentages? I had a mixture of dysbiotic bacteria hence the co-amoxiclav, I then took a lot of probiotics - both vaginal and oral. I had a euploid transfer which was unsuccessful.

I repeated the EMMA and unfortunately my lactobacillus was still 0.00%, this time I only had gardnerella, so the antibiotics had got rid of everything but this, which isn't unusual since gardnerella is anaerobic and would be better treated with a different antibiotic (metronidazole or clindamycin). I was pretty disappointed with the attitude of the lab that does the EMMA, they recommended metronidazole, their treatment protocol is pretty poor compared to another company that tests menstrual fluid, so I used their protocol instead and went at it again: 2 types of antibiotic (oral metronidazole for 12 days and vaginal clindamycin for 7 days), 3 types of vaginal probiotic (twice a day throughout the next treatment cycle) , 3 types of daily oral probiotic. We went straight into another euploid transfer, which again was unsuccessful.

I'm now doing a repeat this time with menstrual fluid testing through fertilysis, the doctor that runs the company does free consultations and said I have the option of going across the Greece and having intrauterine antibiotics if needed. At this point I am pretty despondent, he basically said if we can fix this then I might be lucky and it stays normal, otherwise the best option is to create a window of opportunity with antibiotics and probiotics and hope for the best with a transfer, this is what I would have done with my recent cycle and it still didn't work.

Hi @Gardenlady543 yes, I am going to repeat the test in early January. I had actually asked my consultant if I could add metronidazole this time but typically I haven’t received a response!

I’m sorry you’re having such a hard time sorting this. It sounds like fertylsis are a good option though and hopefully they’ll offer you a more tailored solution. Do you know if the menstrual test is as accurate as the biopsy? I have a tilted uterus which made the biopsy difficult and if I can avoid doing that again I’d be very happy.

Just for info but when this was discovered, I asked my consultant how long it can take to resolve. She said some women take 4-6 biopsies before it is sorted (and probably a shed load of antibiotics) but it sounds like it is possible. I’ve decided to do another egg collection in January/February so that the time spent sorting this doesn’t feel like ‘wasted time’.

Results attached

@CurlyJ21 your results are fairly similar to mine, I had atopobium as part of the original one and now mostly gardnerella.

You might want to book an appointment for free with the doctor form fertylysis to discuss the treatment and see what he says, they actually have one online at 8am tomorrow if you're quick to book. www.fertilysis.com/consultation

I'm nothing to do with that company by the way! I was just impressed with the doctor, who told me the impact of the various bacteria and about targeted treatment.

After 2 biopsies I have decided to move on to menstrual fluid testing because it's hardly convenient to go through a mock FET over and over. The report looks pretty similar and like I said the treatment protocol is more in-depth. I'm more confident with the doctor who will talk and discuss things with patients, Igenomix don't seem interested in having any form of conversation with patients. And even at the time of a terrible second biopsy just gave a minimal standard treatment approach.

@CurlyJ21 bifidobacterium is thought to be a fairly good bacteria by the way as it's also acid producing. If you did want to try coamoxiclav first, then you could try measuring your vaginal pH after. So take the antibiotic course and the vaginal probiotic course and then take some measurements of the vaginal pH after. https://www.amazon.co.uk/dp/B07WNQJGJP/ref=cmswwrcppapiglttfabcE801954HRF61AEE4B50B??encoding=UTF8&psc=1

The garndernalla is likely in both your vagina and uterus at the moment, either the antibiotics will eradicate it or it will stick around, if it does then your vagina pH will be high, so it's a fairly easy way to try and gain some information prior to going through the rigmarole of a biopsy to find out the same thing.

I think if I was in your position I would do that: co-amoxicillin, vaginal probiotics, take the pH, if the pH is high then order some metronidazole, you can do this through an online pharmacy or your Gp, basically if your vaginal ph is high you have bacterial vaginosis, so need the treatment for that. Follow it again with vaginal probiotics if you did take the metronidazole and then go for either a repeat biopsy or the menstrual fluid test.

Hi @Gardenlady543 thanks so much for all of the information and sorry for the delay in responding. I’ve been so busy with work in the run up to Christmas!

I spoke with the doctor at Fertylsis and have received the kit but can’t use it for a few weeks. Have you done yours now? Have you received the results?

I’ve finished the course of antibiotics and I did the ph test last night and (I think) it came back normal which I suppose is good news. Now it’s just a waiting game until I can use the Fertilysis kit and see whether the gardneralla has properly cleared.

That's good that you spoke with the doctor @CurlyJ21 I hope he was helpful. I took my menstrual sample a few weeks ago which I then put in the freezer and then did the vaginal swabs mid cycle on Wednesday, my kit was then collected on the Thursday and was with the lab on Friday, which is pretty good since they're in Greece! It says the results take 5-10 business days so I think it will be the end of this week at the earliest, I'm aware there is Xmas and new year that will impact on timescales. My vaginal pH was a bit off right after my period but it is ok now. So I'm keen to see what the results show.

I take it you're using the vaginally probiotics for 10 days? The doctor told me not to use any for 7 days before the test because it can interfere with the results. He said to take an oral probiotic though.

That’s great that your ph resolved! Fingers crossed the results from the test are positive.

Yes, using the vaginal probiotics (and oral ones). I only managed 9 days before my period arrived but I started them again last night (after I tested the ph). I hadn’t realised you needed to stop so far in advance so I’ll make sure I do that.

I’ve also booked in for a biopsy at the start of January - I can’t decided whether to go ahead with it and compare the results with fertilysis or not. It’s so expensive and invasive so I’d rather not but I’d be very interested to compare the two

@CurlyJ21 I definitely wouldn't do both, since you have paid for the fertilysis test you can do that one, if you need another course of antibiotics then you could have the biopsy after.

I don't think you can compare them, I think the only way to do this would be to take a sample, split it and send it to both companies, I'm not sure if fertilysis can process a solid sample though. I'm pretty sure that both companies look at bacteria RNA, so the technology will be the same.

Hi Ladies
I just found your posts! , I'm going through the same issue. 0% good bacteria lactobacillus and 90% bad bacteria. I took a course of antibiotics and probiotics but didn't work. I'm on another more aggressive course of antibiotics.

Can you let me know your result and if any of what u did worked ?

Also should the partner also take antibiotics and probiotics?

@Rinno
First EMMA I had 0% lactobacillus and a mix of dysbiotic bacteria, I took 7 days of coamoxiclav and then vaginal probiotics.

Second EMMA after treatment I had 0% lactobacillus, this time mostly gardnerella, I took 10 days of vaginal clindamycin and oral metronidazole followed by vaginal probiotics.

I then did a menstrual fluid test and the microbiome was normal.

I wrote this about the microbiome, https://www.reddit.com/r/infertility/comments/rwsxwy/theuterineemicrobiomeemmaaliceemenstrualfluid/?utmmsource=share&utmmedium=iossapp&utm_name=iossmf

You need to take the correct antibiotic for the bacteria you have, consider a longer course and consider adding in a second, while on the antibiotics alternate between a vaginal probiotic and antifungal cream or a low dose antifungal pessary. After take a minimum of 10 days of vaginal probiotics, for the first 7 days use a vaginal acid product like balance activ.

@Gardenlady543 Thank you for ur reply.
And for sharing the article. Very helpful.

How long does it need for the micobiome to be fixed after antibiotics and probiotics? My doctor made me wait 2 months saying that it takes time for lactobacillus to be built. My second EMMA after 2 month showed no improvement. Was wondering if I should do a third test directly after antibiotics and probiotics or also wait for few months.

Did you have success after microbiome was fixed ?

Does the partner need to take antibiotics and probiotics?

@Rinno my third test I had actually taken the treatment and gone straight into a FET, the menstrual fluid which was the lining of that cycle that was tested. The main reason to wait is so that it doesn't pick up the probiotics you have just put in, but I would say you can do the test in the next cycle, I would expect the microbiome to improve once treatment is completed, as long as the antibiotics clear the dysbiotic bacteria. The evidence suggests the partner doesn't need to be treated, but you can do a semen microbiome test to check if your partner is colonised and needs their own treatment.

I had this treatment over a year ago, I have unfortunately gone on to require surgery for fibroids, developed hypothyroidism and pursued immune testament. No success for me as yet.