How to support friends through fertility treatment

“I’m having the procedure tomorrow. Please don’t ask me how it went. When I know, I’ll tell you myself.”

The message arrives on a Wednesday evening while you are doing the washing-up. You read it twice. You type “of course, thinking of you”, delete it, type “good luck!”, delete that too. In the end you send a heart and feel silly. For the next fourteen days, every time her name lights up on your phone, something tightens inside you. You don’t know whether to ask her. You don’t know whether to tell her your sister is pregnant again. You don’t know whether it is better to stay quiet, or whether she will take your silence to mean you don’t care.

If you recognise yourself in this, this piece is for you. Not for the person going through assisted reproduction — but for the person standing beside them: a friend, a sister, a colleague. For someone who would like to help but doesn’t know how, and is afraid that every word will be the wrong one.

Why this is harder than it looks

Infertility is not rare. In 2023 the World Health Organization estimated that roughly one in six adults worldwide experiences it at some point in their life. You almost certainly know someone who has been through it or is going through it — even if they haven’t told you.

And that “even if they haven’t told you” is the first reason support is so demanding. Many people don’t talk about treatment. Studying people attending a fertility clinic for the first time, the British researcher Pauline Slade and her colleagues found that those who felt more stigma talked less with others about their infertility — and that less openness went together with less support and greater distress. Silence, then, isn’t necessarily a sign that someone doesn’t need support. Often it is a sign that they are afraid of what they will hear.

The second reason is that treatment isn’t a single event. It isn’t an operation after which you send flowers and that’s that. It is a sequence of tests, medication, waiting, hope and disappointment lasting months or years — often repeated several times. Support that is enough for one week is not enough for a run like that. How the person going through it feels is described in Assisted reproduction and its emotional cost. Here I will stay on the other side: with you, standing beside them.

The third reason is you. When we witness someone else’s distress, our own fears are set off: that we will say something stupid, that we will hurt them, that we won’t know what to do with the tears. So people often withdraw — not out of indifference but out of discomfort. To someone in treatment, though, that withdrawal often sounds like rejection.

Treatment is not an event but a cycle

You don’t need to know the medical details — those are a matter for doctors and differ from couple to couple. But it helps to understand that every attempt has its own emotional rhythm. Each phase brings something different, so support looks different in each phase too.

The most important thing that follows from this: don’t wait for it to be “over”. Treatment can drag on for a long time, and a person needs people who stay through the third and fourth attempt too — when the news is no longer new and others have grown tired of asking.

Ask what they need — and accept the answer

There is no single right way to support someone. One person wants you to ask regularly, because the silence of others feels like being forgotten. Another, like the friend in the message at the start, can’t bear questions, because each one throws them back into uncertainty. One wants to talk about everything, another about nothing — and would love you simply to go to the cinema with them.

So the first and most useful step is simple: ask. Not “how can I help?”, because that question is hard to answer and someone in distress almost always deflects it with “I’m fine”. It is better to ask something more concrete:

• “Would you rather I asked how it’s going, or waited for you to tell me?”
• “Do you want me to know when your procedure is, or is it easier if I don’t?”
• “When we meet up, would you like to talk about it, or would you rather forget about it for an evening?”

And then — this is the harder part — accept the answer, even if it isn’t the one you would have liked. If your friend tells you not to ask, that isn’t a rejection of you. It is information about how she is getting through this right now. The answer may change, too; in a few months it is worth asking again.

Which words help and which don’t is covered separately in What to say to someone who can’t get pregnant (and what not to). Briefly: avoid advice (“just relax”, “go on holiday”), comparisons (“my cousin also…”) and comfort that denies the pain (“at least you know you can get pregnant”). You don’t need clever words. It is enough not to run away.

Waiting for the result

For many people the hardest part of treatment is the waiting itself — those days between the procedure and the result, when there is nothing to be done, when every feeling in the body becomes a sign and thoughts go round in circles. During this time people often can’t concentrate at work, can’t read, can’t sleep.

What you can do during this time:

• Offer ordinary life. A walk, a film, lunch, a conversation about anything else. Time together doesn’t have to be “therapeutic”. Sometimes the best support is a few hours when they don’t have to think about it.
• Don’t ask “Any news yet?”. When she knows, she’ll tell you — if she wants to. During the wait, that question works as pressure she is already carrying inside.
• Don’t predict the outcome. Neither “I have a feeling it’ll work this time” nor “don’t get your hopes up”. Both are weight she doesn’t need. Stay in the uncertainty with her.

When the news is bad

When an attempt fails, the people around often don’t know what that means. There was no pregnancy, so there was no loss — that’s how they think. But for someone who has invested their body, time, money and hope in that attempt, a lost attempt is a real loss. Sometimes behind it there was a heartbeat seen on a scan for the first time, sometimes an early pregnancy that ended. The researcher Kenneth Doka calls this disenfranchised grief: a grief that others fail to recognise — I wrote about why in The grief nobody acknowledges: miscarriage, divorce, losing a job.

In that moment nothing needs fixing. No looking for reasons, no offering the next step, no rushing to “next time it’ll work”. You can say simply: “I’m so sorry. I’m here.” And then you are there — a week later too, a month later too. When a colleague or friend is grieving: how to stay longer than a week is about exactly this: support after a loss usually comes in the first few days and then vanishes, just when it would be needed most.

Here is how a conversation the day after bad news might sound (composite, not a real person):

“I don’t want you to tell me it’ll happen next time.”
“I won’t. I don’t know if it will.”
“Everyone keeps saying it. As if this one was just… nothing.”
“It wasn’t nothing. You lived for it for three months.”
“…Yes. I really did.”
“Do you want me to stay, or would you rather be alone?”
“Stay. We just don’t need to talk.”

Nothing special happens in this conversation. The friend says nothing wise. But she does three things that count: she doesn’t promise what she doesn’t know; she names that the loss was real; and she asks what the other needs instead of guessing.

When you are the one who is pregnant — or has children

One of the hardest situations in a friendship touched by infertility is when you become pregnant yourself or already have children. Many people in this position feel guilty, as if they had taken something from their friend. And many decide to hide the news for as long as they can.

A few things that usually help:

• Tell her yourself, before she hears it from others. Finding out at a shared party or on social media is far more painful for someone in treatment than hearing it from you.
• Tell her in a way that leaves room for her reaction. Many people say it was easier when they received the news in writing, because they could react on their own first — tears included — and only then reply. You might write: “I want you to hear this from me. You don’t need to reply now, and I understand if it’s hard for you.”
• Don’t expect her to celebrate out loud. She can be glad for you and grieve for herself at the same time. If she withdraws for a while, that isn’t the end of the friendship.
• Don’t hide, but don’t push either. Don’t shut her out of your life because you’re afraid it will hurt her; leave that decision to her. Invite her to the christening and tell her explicitly that you understand if she doesn’t come.

You are allowed to feel what you feel too: joy, guilt, even a little resentment because you can’t share your happiness the way you would like. All of that is part of a friendship that has held through a hard time.

Don’t forget the other partner

When we talk about support during treatment, we almost always think of the woman. She goes to the appointments, her body is at the centre, she gets the questions. Her partner often stays on the sidelines — in friends’ eyes too. Hardly anyone asks him how he is.

Men going through treatment often carry their grief quietly, because they feel they have to be “the support”, and because there is no place where they are allowed to fall apart. For same-sex couples or single women going through treatment the picture is different again, but the question stays the same: who asks the one standing on the side?

If you are the partner’s friend, ask him. Not “how is she?” but “how are you?”. And be prepared for the first answer not to be the true one — for that to come only with the second or third.

The circle of comfort

Some years ago the American psychologist Susan Silk and the mediator Barry Goldman proposed a simple picture they call “ring theory”. Draw a circle and put the person at the centre of the crisis inside it. Around it draw a larger circle for those closest to them, around that a larger one for friends, then one for acquaintances. There is only one rule: comfort goes in, complaints go out.

This means: towards your friend in treatment you send listening, help and presence. Your helplessness, your fear, your sadness about her distress or your disappointment that she has withdrawn — those you don’t put down with her. You take them to someone further from the centre than you are — your partner, another friend, a therapist.

The picture is useful because it relieves you of two things: you don’t have to hide that it’s hard for you, and you don’t have to feel guilty that it’s hard for you. It’s just a different address. If you want to see who the people in your own circles are, the map of your support network tool can help.

Why does simple presence matter so much? Research on infertility and social support suggests that feeling you have people you can rely on goes together with lower infertility-related stress — partly because it helps people face their distress more openly instead of withdrawing into themselves. Support, then, doesn’t change the outcome of treatment. But it changes how you get through the treatment itself.

The key is what psychology calls empathy — the capacity to sense what it is like for someone else without replacing their experience with your own. Empathy doesn’t mean you know what it’s like. It means you are willing to ask and to listen to the answer. You can read more about how infertility affects psychological wellbeing under infertility and distress.

In relational family therapy, in which I am training, we often see how deeply we are shaped by who was with us in hard moments — and who wasn’t. A friendship that survives years of treatment often becomes one of the deepest in both people’s lives. Not because it was easy, but because it turned out to hold.

Exercise: one month of presence

This exercise is for you, if you want to stay beside your friend for longer than the first few days. Take ten minutes, your calendar and your phone.

1. Ask what suits her. If you haven’t yet, send her one of the questions above — for example, whether you should ask or wait. Her answer is the basis for all the next steps.
2. Put four reminders in your calendar — one a week. Not on days you know she has a procedure, but on ordinary days. Support that arrives on a random Tuesday says: I think of you even when nothing is happening.
3. At each reminder, send a message that doesn’t need a reply. For example: “Thinking of you. No need to reply.” Or a photo of something that would make her laugh. The last sentence matters — it takes the obligation away from her.
4. Once a month, offer something concrete. Not “let me know if you need anything”, but “I’m going to the market on Saturday, shall I bring you something?” or “I’m free on Thursday, fancy a walk?”. A concrete offer is easier to say yes to.
5. At the end of the month, check in with yourself. How did you feel doing this? Do you have someone you can take your own feelings to? If not, that is the next step — for you.

None of this will solve her distress. But people who have been through treatment often don’t remember the clever words. They remember the ones who stayed.

Where this advice doesn’t apply

I would like to set some limits to what I have written, too.

First: you are not her therapist and you can’t be. A friend’s support is precious precisely because it is different from professional help — ordinary, human, unplanned. If you notice that your friend has been low almost every day for a while, isn’t sleeping, is withdrawing from everything or says nothing makes sense any more, suggest she see her GP or a psychiatrist. If she mentions thoughts of death, help her call, in Slovenia, the mental health crisis line on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritans helpline on 116 123 (24 hours a day); in an emergency, 112. Research shows that psychological burden is one of the more common reasons people stop fertility treatment — so professional support during treatment is not a luxury.

Second: you have your own limits too. If supporting her is taking more than you can give, that isn’t shameful; it is information. How to stay beside someone in distress without wearing yourself out is the subject of How to support someone with depression without burning yourself out — although it is written about depression, the same applies. A short explanation of what boundaries are and why they aren’t rejection is in the knowledge base under boundaries.

Third: sometimes a friendship changes with infertility, however hard you try. Someone withdraws because they can’t cope with being around pregnant people or families with children. That isn’t necessarily your fault and isn’t necessarily for ever. Sometimes the best support is precisely not to insist — and to tell her clearly that the door is open when she is ready.

And fourth: all of this is written from the perspective of someone who isn’t at the centre. People in treatment are very different from one another. If your friend tells you something different from what is written here, she is right. General advice is here to help you start, not to be used instead of a conversation. Why even well-meant advice from loved ones so often misses the mark is described in “Just snap out of it”: why advice from loved ones does not help.

What to remember

• Treatment isn’t one event but a cycle that can repeat several times — support needs to last longer than a week.
• Ask concretely what she needs (questions or quiet), and accept the answer even if it isn’t the one you wanted.
• A failed attempt is a real loss. Don’t try to fix it and don’t rush to “next time it’ll work”.
• Comfort goes in, complaints go out: take your helplessness to someone who isn’t at the centre of the crisis.
• You are not a therapist. If distress lasts or deepens, help your friend find professional support — and look after yourself too.