Clinical specimen: Endometrial biopsy/high vaginal swab/Menstrual Blood (D1) 
TEST DESCRIPTION: 
1. The microbiome are the microorganisms which include bacteria, fungi, viruses, parasites. The balance of microorganism mainly bacteria and fungi in the endometrium is a key factor for successful embryo implantation. In normal conditions, Lactobacillus are most dominated species in the endometrium. But the presence of dysbiosis or pathogenic microorganism may alter the endometrial microbiome and can disrupt the uterine environment, causing implantation failure and pregnancy loss. 
2. The most prominent example of a pathology caused by an altered endometrial microbiota is chronic endometritis (CE). CE is characterized by the persistent inflammation of the endometrial mucosa, caused by the presence of bacterial pathogens/fungi/virus in the uterine cavity. Because CE is usually asymptomatic and undetectable through vaginal ultrasound, it is often overlooked. The prevalence of CE in infertile patients has been estimated to be approximately 39%; it has been reported as high as 60% and 66% in patients with recurrent pregnancy loss (RPL) and repeated implantation failure (RIF), respectively.
3. The Cordon Endometrial Microbiome Analysis (EMA) Test is based on metagenomics next generation sequencing which can detect and quantify >2000 microorganisms (bacteria/fungi/cytomegalovirus/herpes simplex virus). CEMA test uses the latest highly accurate short reads Next Generation Sequencing (NGS) technology to determine the complete endometrial microbiome profile from endometrial tissue or endometrial fluid. It also provides information on the detection and quantity of specific bacteria/fungi/viruses causing ICE. The technology is based on total nucleic acid extraction (DNA/RNA) followed by targeted amplification and sequencing. This enables the taxonomic assignment and relative quantification of each microorganism present in a sample. 
4. Microorganism are classified into 3 phenotypic groups based on phenotypic characteristics. 
Phenotypic group 1: Phenotypic group 1 represents obligate and opportunistic pathogens which can cause disease at any quantity. 
Phenotypic group 2: Phenotypic group 2 represent commensal pathogens which can cause disease due to dysbiosis but may also represent normal microbiota. 
Phenotypic group 3: Phenotypic group 3 represent healthy microorganisms which can help maintain normal microbiota and endometrium health. A balanced microbiome improves the reproductive prognosis, resulting in increased chance of pregnancy and live births. 
Clinically relevant microorganisms from phenotypic group 1 and 2 are reported. For complete list of microorganisms detected this test please visit this link https://cordondiagnostics.com/pathogens/