Hiya,
I'm 33 and been struggling to conceive our first for 16 months now. After a year we had all the tests done, all results normal apart from possible mild endometriosis on my side.
Here's my advice to your friend, she may have done some of this stuff already but I'll list just in case:
1. Buy 'Taking Charge of your Fertility' by Toni Weschler and 'It starts with the Egg' by Rebecca Fett. After reading countless books I've found these two the most useful of the lot.
2. Supplements, reduce booze and caffeine intake. Zita West one's are pretty good but expensive and you have to remember to take them 3 times a day which is a bit of a faff. I'm currently taking daily 1000iu Vitamin D, Pregnacare conception, Ubiquinol Q10 400 mg, 300mg Alpha Lipoic and Omega 3.
3. Make sure to have sex at the right time...basic stuff I know but you'll be surprised, we wasted at least four months doing it at completely the wrong time! As soon as there's egg white cervical mucus, start every other day usually from CD 8-10 onward, depends on what her cycle length is. If there's not much of that going on down there, I've noticed an improvement from drinking more water and grapefruit juice! There's also Conceive Plus and Pre Seed you can use. Start doing ovulation tests, I recommend the Pink Clear Blue digital one, don't bother with any of the others. The Purple Clear Blue digital dual ovulation test I've found to be temperamental, it's either never flashed (does this when it's meant to show 4 days of high fertility before ovulation) and gone straight to solid smiley, or it's just flashed constantly. The cheap strip tests are hard to read the two lines, and you end up wasting time squinting at it wondering "is that a line?", "is that second line dark enough?", "where are the bloody instructions for these things again" etc. The Clear Blue Digital Monitor often missed my LH spike and I ended up getting 10 days of solid high readings resulting in an exhausted husband. Depending on cycle length (27-30 days) start testing from day 10 onward around 10 am every day. As soon as you see the smiley face get busy that night, the following night and the night after, have a night off and then the following night for luck. This logic goes by the Sperm Meets Egg plan that a lot of women have had success with. If you've been doing it every other day for around 4 days or so before you get the first smiley on the Pink Clear Blue ovulation test, you should have covered all your bases well.
4. Start monitoring Basal Body Temperature. Up to her, but personally I got fed up with this pretty quickly. Literally I'd wake up at the same time every day by my alarm clock, faff around half awake trying to find the darn thing on the bedside table, haphazardly stick it in my mouth trying not to take my eye out in the process or knock a tooth, then be too afraid to move in case it changed the temperature some how, busting for the loo, wondering whether the temperature was going to be inaccurate because I wore socks in bed overnight, or the window was open, or I'd got up to go to the loo at 4 am...basically a constant daily reminder I was still infertile, no woman needs that first thing in the morning! If she decides to go ahead she'll need to buy a BBT thermometer, can get off amazon, set alarm the same time every morning and take temp without moving around - there are various apps that can help, you just need to put your temps in daily and they'll build a chart for you and put cross hairs where they think you ovulated (Kindara, Fertility Friend are both pretty good). Personally, I use Ovusense, which takes all the guess work out of it, its a sensor you wear overnight you plug it into a monitor the following morning and it tells you when your fertile period is, then after 2-3 cycles predicts ovulation up to a day in advance, it also creates a chart for you so you can see that biphasic change in temperature. On the chart you want to see a difference in temperature, lower temperatures from CD1 to 14/15/16 depending on when you ovulate and then a spike in temperatures which level out until your next cycle begins where your temp will drop again. There is no way of accurately predicting ovulation until after it happens, some women get a dip in temperature just before or on the day, then a sharp rise, you need 3 consecutive temp rises in a row and you should have ovulated 3 days before those rises. Don't bother with DuoFertility, tried it, it takes your external body temperature so can never be as accurate. Kindara are actually bringing out their own thermometer soon called 'Wink' that wakes you up with an alarm each morning, it'll take your temperature and then creates the chart for you, notifying best time etc.
5. Get some acupuncture, my cycles before were all over the place, spotting before hand etc. They are now every 28/29 days, usually ovulating on CD15. I'm currently seeing Zoe Lake at Neils Yard on Northcote Road and found she's great.
6. If she's been doing all of the above and still no luck, it's time to get some tests done. Don't bother with the NHS, been there, done that...took forever. If she's impatient and like me just wanted to know what the heck was going on, go privately. I went to the London Clinic and had AMH (checks how many eggs you have left), FSH (checks quality of eggs), Blood profile, Thyroid (checks your hormones), Progesterone (checks you ovulate), I also had a smear (check for cervical cancer) and a transvaginal scan (checks follicle count, ovaries, polys, lining etc) and HSG (checks your tubes aren't blocked). I saw Dr. Emma Kirk who in my opinion did the bare minimum, I had to follow up with her secretary to get the results every time which when you are paying a lot of money you expect to receive in a timely manner preferably have some contact with the doctor or a follow up, basically felt like a sausage in a big machine there. If I could step back in time and do it again, I would have gone straight to the Lister and had them all done there.
7. If all results are normal start considering IUI, or IVF. We went to the Lister clinic in March for a consultation and were advised a few cycles of IUI and if no luck then move onto IVF. IUI obviously has less of a success rate but is advised for couples like us where there's no obvious reason. It's also far less invasive than IVF. We're going to start IUI in September this year, I'm planning on taking the NK cells immune test before so that I can rule that out before starting otherwise waste of money getting anything done after if my immune system is the cause. I've seen both Dr Shabana Bora and Dr Raef Farris who are both great! Dr Farris is very funny and positive which is what you need at that time.
8. Never. give. up. I can account to it being a pretty lonely time, particularly when it feels like everyone and their bloody cat is falling pregnant around you with ease! Everywhere you look there's yet again another smug woman with a big bump walking by and you find yourself subconsciously yelling "SERIOUSLY, what the heck do I need to do!!" She's not alone! I've found subscribing to youtube channels of other couples struggling helpful, taking part in forums online and trying to be positive about it. It'll happen, everyone's journey is different that's my philosophy on it anyway.
Anyway hope this helps, if she has any other questions PM me on here and lots of luck.
