Whenever people ask how to support "friends who are having trouble," we infertiles are delighted to respond.  So here are some of my favorite things to suggest to anyone who wants to support a friend or family member struggling with infertility.

1) Ask.  The silence and taboo around infertility drives us crazy.  We usually would love to talk about it.  If we don't want to talk about it, we will say so.  A nice way to ask is to find a way that doesn't assume anything.  The age-old "So, when are YOU two having kids?"  assumes that the couple in question knows when.  If they are having trouble, they have no idea when it will happen.  If you find yourself asking in vague and clumsy ways, that's okay.  Clumsy beats smug or cutting every time. 

2) Don't give advice.  This is something we often hear but rarely heed.  Advice takes many forms.  Telling a story about a friend who "finally got pregnant after blah blah blah" isn't always helpful, and sometimes is really stealth advice, telling us that we should try blah blah blah since it worked for your friend.  Advice-giving is love, I know; it's a way of saying "I wish I could fix it."  But you can't, and we have heard all of the suggestions, and tried them, and if we are still infertile, they didn't work.  Instead, try saying "I wish I could fix it but I probably can't."  Don't suggest doctors that got your co-worker pregnant, or books that got your sister-in-law pregnant.  Trust me; we have heard it all, and read it all, and switching doctors is something we agonize about regularly.

3) Learn something new.  If something bad happened to your friend that you don't understand, look it up yourself.  Don't make her explain it.  If you looked it up and you still don't understand it, you can at least say to your friend "I googled 'ectopic pregnancy' but I still don't understand why they can't fix that..." your friend will appreciate your efforts.  A lot.  However, if something good happened to your friend, let her explain it; she will enjoy talking about it some more.  But don't let your increased level of knowledge turn you into an advice-giver.  If your friend has explained a procedure or situation more than once and you "still don't get it," take a look at yourself.  Sometimes we don't like to learn about the details of the procedures because we have some objection or feel squeamish hearing about it.  If that's an issue for you, we will figure it out after we explain the same thing to you four times, and it makes us feel even more alone.   If you aren't able to give support by listening to all the details, maybe you can give support in other ways.

4) Meet your friend where she is.  If your friend is 42 and newly married and "has a really good feeling" she will get pregnant, smile and celebrate her good feeling.  Don't quote her the medical odds.  If your friend is feeling completely hopeless and doesn't think her IVF has a chance in hell, don't try to talk her out of it.  Just say something supportive and let her know you love and support her.  Hope lives outside of logic.  Both hope and the lack of hope have a purpose in our process, and you can support your friend by accepting that.

5) Look at your own stuff.  If you find yourself feeling irritated or impatient with your friend, if you think she should just "relax" or that she should just "let it go," you may have feelings of your own on the subject.  If for whatever reason you discover that supporting your friend or family member is too hard or seems to cause you stress, step back.  Infertility is a deep issue and kicks up feelings in people who have not been touched by it, and if your own stuff is making it hard for you to support your friend, don't try to suppress your own feelings.  You might end up being one of those "bad friends" we all blog about.  Infertility is a friendship-killer.  This is often a problem with mothers and daughters, or sisters, or best friends; someone else's stuff is enmeshed with our own.  An example of this is the woman who feels eclipsed by her older sister, and just when she gets pregnant, her older sister's infertility means her own pregnancy can't be celebrated in the same way.  Long-standing feelings of jealousy and competition between the sisters may be inflamed by this situation and everyone will need to proceed with caution.

6) Make pregnancy announcements with care.  If you have friends you know or suspect may be "having trouble," let them know by email, letter, or voicemail message.  Many of us feel deep pain when hearing someone is pregnant, and then suffer agony that we aren't able to "just be happy for you."  Give us a way to hear your news in private, so that we don't have to manufacture joy for you face to face.  If you know that someone close to your friend is about to announce her pregnancy, warn the friend.  Especially if the announcement will be public, like at Thanksgiving dinner or at a work meeting.  Sometimes even a vague comment like "Suzette has some big news for you" will clue the infertile friend in.  Many of us infertiles dread these announcements and when we hear that someone has big news, we assume that it will be a pregnancy.   Some might think it inappropriate to tell someone else's news, but I hope that any pregnant woman wouldn't mind the betrayal of a confidence if it would save her friend deep pain.  Should your infertile friend "just be happy" for you? Absolutely.  She would if she could.  Try to find some compassion for her.  She doesn't have a choice right now.  Help her find happiness for you by letting her know pregnancy news ahead of time, in private.  Keep inviting her to showers but let her know you won't be insulted if she has to decline.

7) Wear the target with love.  Your infertile friend may go through stages of deep anger.  If you have children or become pregnant during this time, you may experience this anger up close and personal.  If it's too scary then you'll have to distance yourself.  But if you can handle it, try to let your friend know that you can.  Give her room to vent, and let her know that anger is a sane response to loss and stress.  Don't tell her you know how she feels because you didn't get the job you wanted, or because you had a miscarriage before you had Caitlin and Joshua.  As long as the kids score is You 2, Her 0, you don't know how she feels.  Is this unfair?  You bet.  But you'd enjoy this kind of support very much if the situation were reversed, wouldn't you?  And keep in mind that the season of anger is will end.  It will end even sooner when the anger is vented and expressed.  Suppressed anger underneath a fake smile has a longer shelf life than Twinkies.  In a few years your friend may be able to smile and say "I was really angry then and I'm sorry I put you through it."  Or, in a few years your friend may not be your friend any more.  You can decide which result you want.

8) Know the facts.  No one "just adopts." It costs $15,000 minimum and often takes more than a year.  Adoptions can fall through, and when they do, it's as deep a pain as any miscarriage.  Women in the process of adopting are no more likely to get pregnant than women who are not adopting.  IVF can help women get pregnant, but the chances of successful IVF over age 40 are less than 5% unless a woman uses donor eggs.  The chance of spontaneous, unassisted pregnancy after age 40 is rarely higher than 5% in any given month, and rarely exceeds 20% no matter how long the couple tries.  The chance of success in any IVF cycle, at any age, rarely exceeds 60%.  "Relaxing," going on a vacation, or reducing stress is generally good for overall health, but will have no effect on the majority of infertile couples who have diagnosed medical problems.  No matter how many healthy babies a woman delivers, the miscarriages or babies lost in infancy will never be replaced and are uniquely grieved.

9) Let God speak for himself.  Your religion may have informed your opinions about having babies, or not being able to have them.  Even if you and your friend share the same faith, you may come down differently on certain topics.  Don't presume that your interpretation is law, particularly if you haven't experienced the same situations your friend has.  Infertility is agonizing for people of faith, because we feel betrayed not just by our bodies, but also by our God.  If God is good, how could He allow this?  This is a difficult question all of us will be confronted by.  Give your friend room to question and wrestle with her religion in difficult times.  If you feel that God blessed you with a miracle pregnancy, don't brag about it.  Don't say that it happened because "God heard our prayers" - does God only hear some prayers? - or because you read your Bible, or because God gave you a promise.  God is mysterious, whether life is going well for us or not.

10) Know the terms.  A child isn't "adopted."  It's not an adjective, it's a past tense verb: he or she "was adopted" and is now a regular kid in a regular family.  Don't make it a label.  Don't say that a couple "adopted" and then had "one of their own" - all their kids are their own, regardless of biology.   Don't ask if a 43-year-old's pregnancy is "natural" - she isn't having a robot.  A pregnancy may be spontaneous, or it may be the result of fertility treatments, but no mother wants to be asked if her pregnancy or her baby is unnatural.  In IVF, eggs are taken out of a woman's body, but they are fertilized in the interim.  Embryos are transferred, not eggs.  In IVF, the embryos are transferred, not "implanted."  Implantation equals pregnancy, which the doctors cannot accomplish.  They can only transfer the embryos and hope.  Doctors transfer, God implants.

11) Work from your strengths.  Are you having trouble sorting out the facts when your friend talks through her procedures?  Don't be afraid to ask "That's good, right?" or "What's the next step?" Don't apologize.  If you think you disagree for religious reasons, just tell her you'll pray for her.  And do it.  If you are afraid of the anger, distance yourself and send notes or cards.  If your friend has a loss or a surgery, make lasagna or brownies.  Give her rides.  Offer to babysit in the early morning, so she doesn't have to take a child to the infertility clinic when she goes in for her frequent appointments.  If she's too afraid to hope, tell her you'll hope for her. 

12) Be grateful.  Let your infertile friend know how grateful you are for your pregnancies and your children.  Understand that fertility is a gift and not a right, and that you got the gift when some did not.  Let your friend's infertility teach you about what you've been given, and let her know that her pain is helping you not take life's gifts for granted.  If you're around other couples who assume everyone is fertile, let them know too.

13) Don't just ask. If you ask "what can I do?" and the person actually tells you, do it.  I've had friends ask what I need, and I've then told them, and then they didn't do it.  It hurts a lot, and then we end up hemming and hawing when people ask again what we need, afraid to be disappointed again.  This helps no one.  Staying in touch is good, and can be easily done with minimal contact if you haven't the time or emotional energy.  Sending a card is appreciated, an email can be sent at any time, a voice mail message when you know the person won't be home is better than nothing.  "I'm sorry for your loss" is a perfectly good sentiment, as is "I'm thinking of you" or "hoping for you" or "wishing with you" or whatever.  If you do ask, make it specific, like "I'd like to cook you something, would you like lasagna or fruit salad?" or "I can take Joshua in the morning next week, how about Tuesday or Wednesday?" or "I'm prepared for bad language and venting, wanna take a walk?" Most people can do at least one thing really well when supporting a friend - don't be afraid to offer something specific.  Your friend will say yes or no and will appreciate your offer very much, even if she hates lasagna or wouldn't trust you with Joshua's early morning crying jags.

Any questions?