Around one in seven couples in the UK have difficulty getting pregnant, which can exact a huge emotional toll. It's only natural to want to offer words of support to a friend going through infertility, but it can be tough to put yourself in their position if you haven't experienced it. And all too often, people with good intentions can make insensitive comments - even when they don't mean to.
Emily* says she received a number of unhelpful comments from others when she was struggling to conceive, such as 'just relax and it'll happen'.
"It ignores that there is usually an underlying medical cause for the problem," she says. "Anther was 'At least you'll never have to use contraception', which seems like a poor silver lining.
"The phrase 'just adopt' makes the whole process seem like it's simple, and it is certainly not. 'I’ll be your surrogate' ignores the fact that we're currently trying to conceive via IVF and almost assumes we'll fail," Emily adds.
She says these comments made her feel frustrated at the lack of understanding of infertility. "It would be much better if people asked how it made people feel and offered practical help instead, like taking people to appointments."
Maria* says she and her partner were asked which one of them was 'not working properly'.
"It's incredibly insensitive and hurtful," she says. "Infertility investigation and treatment leaves you feeling vulnerable and frustrated with your body. You believe that you are somehow faulty or not working properly, assigning yourself blame for the problem, which is soul-destroying and humiliating.
"Another common remark is 'Maybe it just isn't meant to be'," Maria adds. "When you are giving everything you have, every month trying to achieve your ultimate goal, it is beyond unhelpful. It is unkind, untrue and without sympathy."
Impact on well-being
"Fertility is too often a taboo subject and it can be hard for anyone who has not experienced fertility issues, to understand how devastating it can be," says Aileen Feeney, chief executive of the charity Fertility Network UK.
According to a 2016 survey by Fertility Network, 90% of respondents reported feeling depressed due to their fertility problems - and 42% said they felt suicidal.
Moreover, the heartache of not being able to fall pregnant is often exacerbated by the physical and emotional rigors of infertility treatment, which can be a long, invasive and challenging process.
"Infertility already makes you feel depressed, despairing and hopeless," Maria says. "Some comments make you feel like you can't open up to your friends and seek the support you desperately need. You are left feeling humiliated, isolated and like your experience is unimportant."
Part of the problem is that not enough is known about infertility. A lack of awareness can lead to comments like 'just adopt' when in reality, adopting is far from an easy process.
The same goes for in vitro fertilisation (IVF) - one of several techniques available to help people with fertility problems have a baby - which can be invasive, expensive and emotionally and physically draining.
Misinformation can lead to more women blaming themselves for their fertility problems, too. For example, suggesting it is easy for most women to get pregnant is not necessarily true. Although many couples manage to conceive, many have problems with fertility. Being told to 'stop worrying and relax' suggests infertility is psychological, which it is not.
"The most common myths surrounding infertility are that it is an older women's issue and that IVF is for women who have 'left it too late' - not true," Feeney explains. "In fact, female fertility is falling from the age of 28 or earlier. Most women having IVF started trying to conceive in their early 30s or sooner, and the most common cause of infertility now is down to male factors."
There is no one cause for fertility problems and for a quarter of couples, a cause can't be identified. In women, infertility may be caused by a problem with ovulation or with the Fallopian tubes, or by non-cancerous growths called fibroids in or around the womb. Endometriosis, a condition where small pieces of the womb lining start growing in other places, or pelvic inflammatory disease, can also cause fertility problems.
In men, infertility can be due to too few sperm or poor sperm quality, or because of damage to the testicles - for example, because of injury, infection or cancer. Medications can also cause fertility problems in men and women.
According to the NHS, around 84% of couples will conceive naturally within a year if they have regular unprotected sex. For those who have been trying for more than three years without success, the likelihood of getting pregnant naturally within the next year is 25% or less.
So what should you say?
The wrong comments can be hurtful and insensitive, so Feeney advises to just listen to someone facing fertility challenges and avoid trying to solve, judge, minimise or compare. "An empathetic, understanding ear will be much more appreciated than you realise," she says.
Alice Rose, 35, launched a campaign called Think! What Not to Say which aims to help people understand what not to say to anyone going through a fertility struggle.
"If someone you know is going through infertility, try not to offer advice," she says. "We all want to help and often when someone tells us they can't get pregnant, we want to fix the problem for them by sharing stories of people we know who tried relaxing or going on holiday - but doing this actually really undermines the complexity of their struggle.
"Just be a friend and support them as you would if they were going through any other difficult experience - ask if they want to talk about it, and if they do, be there for them - stick on the kettle, go for a walk, send them a thoughtful gift. If they don't, just let them know that you're there, in any way you can, for when they do want to talk."
Infertility is usually diagnosed when a couple hasn't managed to conceive after a year of trying. Your GP will be able to refer you to a specialist to try to determine the cause. The treatment you are offered will depend on what's causing the problem and what's available from your local clinical commissioning group.
There are three main types of fertility treatment: medicines, surgical procedures and assisted conception, which includes IVF and intrauterine insemination (IUI).
Fertility problems can be a heavy burden to bear, so it is essential to get support and help from friends, family or professionals. Fertility Network has an Information Line and email service that you can use to ask questions and get advice, as well as a Nurse Support Line, run by an experienced fertility nurse. The charity also offers face-to-face and online support groups.
If you are struggling to cope and it is impacting your mental health, your GP may be able to refer you for counselling or psychotherapy, which can help you work through negative thoughts and develop coping strategies to manage stress and anxiety.
As infertility and its treatment can cause stress, relaxation techniques can also be beneficial, such as mindfulness meditation, deep breathing and yoga.