Anyone else’s doc refuses to prescribe antibiotics in case of issues in the uterine or vaginal microbiome?

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I’m about to have my first euploid transfer in a couple of months. I’m 30 and have 1 living child conceived a few years ago. My AMH is on the low side for my age.

For personal reasons I can’t have my FET for a few months so I was talking to my doc about what I could usefully do in those few months to maximise my chances of a successful FET. Whilst I obviously don’t want to waste money, I would be ok with paying for some “just in case” tests to avoid wasting those precious embryos I’ve worked so hard to get.

He said that he isn’t keen on doing any tests and that most cases of failed transfers (even euploids) are due to embryo issues, not uterus / woman’s body issues. I bought a Fertilysis test to do at home (similar to EMMA / ALICE but done with a swab rather than biopsy) but he’s said that even if issues are found he would not prescribe antibiotics, because those would also destroy the good bacteria in my uterus and vagina. Instead, I should take vaginal probiotics.

Seems to contract what I read on here: so many women have endometritis that causes failed FETs and then, once it’s treated with antibiotics, the woman has a successful FET.

That seems strange - my understanding is if it isn’t diagnosed they can give you a course but slightly lower dose/shorter course than if it is diagnosed. I’ve seen two consultants who have both happily prescribed me antibiotics as I didn’t want the biopsy done, there were no questions asked. Can you ask another doc? Or just ask again? :)

@Elmo2025 annoyingly I've asked it in so many various ways.
He's the same with doing investigations like a laparoscopy, NK cells, or anything else (I've had a hycosy though, before him). Says a lack of implantation or a miscarriage is usually an embryo issue rather than a womb issue.

Did you do other investigations before a transfer or just the antibiotics?

Hmmm I would maybe change clinics. Have you had your embryos pgta?
my doc was similar in saying it’s most likely age, but let’s rule out xyz. I’ve had a lap, hysteroscopy and husband has had dna frag. I did fall pregnant after my lap, but sadly miscarried. We have one frozen embryo left x

@Elmo2025 yes all embryos were PGTA. He's done all the embryo-related tests ie dna frag, pgta, semen analysis etc - anything that goes into testing the embryo itself. Just doesn't seem keen to test my body

Many things could affect failed implantation. I am on 5 failed FETs at the moment and going into my 6th. Before this one, I had further tests - ERA/EMMA/ALICE, ERA came back saying they are transferring a day too late and the scans also picked up i have a Y shaped uterus, which isn't good. These both could be impacting the implantation for me.

I mean T shaped not Y.

Have a look on Reddit for discussions on endometritis. Many women have said it stopped them conceiving and are upset it was not tested for or treated before they transferred embryos, which were ultimately unsuccessful likely because of the infection. I’m currently on a 14 day course of antibiotics after testing positive from a biopsy taken at my last egg collection. I’m pleased it was caught before I transferred embryos. I’d never heard of it before I was diagnosed and it seems in most cases to be relatively easy to treat.

@ZarZarGabor can I ask what dose of antibiotics you are on? Thanks

Doxycycline 100mg and flagyl 500mg, I take tablets twice a day for 14 days and some probiotics too . I understand the dose is quite strong but I think that’s because they want to avoid having to re biopsy to test if it’s gone, because that risks triggering a new infection

Just to clarify I’m not in the UK so possibly have been offered different mediation to the UK

Thanks @ZarZarGabor So Doxycycline 100mg twice a day? So 200 mg total (plus the Flagyl). I think that Doxycycline dose is the standard one in the US -but in the UK it tends to be 100 mg once a day (and only then if you are actively diagnosed with something, they won’t give it preemptively)

It’s just interesting- my successful IVF round which gave me my son, happened to be the one in which I’d been taking doxycycline for a eye infection for a few weeks before hand (admittedly at the lower 100mg a day dose).

And I do have some left over - so I’m now tempted to take it before my final frozen transfer too. I have some endo symptoms but have never been formally diagnosed - and I’m wondering if the antibiotics could have been the thing that made the difference after so many previous failures, it’s very tricky to tell.