With the rush of hormones, the all-encompassing uncertainty, endless doctor visits, and shelling out thousands of dollars, there’s no doubt that going through Assisted Reproductive Therapies (ART) like in vitro fertilization (IVF) is challenging for anyone who wants to expand their family. And it can be tough to know what to say or do to support a friend going through IVF.

“IVF makes you exhausted in every aspect of the word, and the way you see the world changes in a lot of ways,” explains Amber L, 33, who conceived after three IVF cycles. “The people around you can really make things better or worse for you as well.”

Amber and her husband had been trying for eight years and experienced a miscarriage before ultimately conceiving. She says she learned a lot about how much to personally share during the process.

“I tried being open with family, friends, and certain co-workers in the beginning because when you’re on so many hormones, people can sort of tell you aren’t quite yourself, so I thought it would be better to be completely open,” Amber explains. “After a while, I felt I could no longer share because of some comments people made that were so hurtful.”

To help you best support your loved one, we’ve asked experts what helps, what hurts, and ways to be mindful of their feelings during this very sensitive time.

How to respectfully check-in and support a friend going through IVF

“I think the number one thing is to ask the person what’s helpful for them,” says Sarah Holley, PhD, staff psychologist at the Center for Reproductive Health, and health sciences assistant clinical professor at the University of California, San Francisco. “Different people want different things from their support system and their friends.”

Dr. Holley also suggests asking a friend to do something to take their mind off the IVF process can help. “Some people are private about the process and don’t want to share the details of it,” she explains. “Help may take the form of just being there and providing distraction in the form of going for a walk, talking about other things, or going to see a movie.”

If you’re looking for the perfect thing to say, just know that it may not be out there. “There’s very little someone can say to make infertility and IVF less painful,” Amber admits. “I felt most supported by friends or family who said things like ‘I’m sorry, I wish this was easier for you, please let me know if you need anything, or is there anything I can do to cheer you up,” she says.

“It was nice to have people acknowledge that it is a difficult process that they don’t fully understand, but that they support you and love you,” Amber explains.

Things you definitely want to avoid saying to someone going through this process

“Being told everything happens for a reason or you aren’t meant to be a mother or being shamed for wanting children of your own are some of the most painful things I’ve ever been told and are still hurtful today, even though I’m 35 weeks pregnant with my miracle baby,” Amber explains. “It’s just something you never forget. Comments like this or things like toxic positivity just aren’t helpful.”

While some comments Amber says she endured were well-meaning, but ultimately still hurt, others were downright insensitive. Here are 10 things to definitely avoid saying to a person going through any type of family-building treatment:

• “Maybe God doesn’t want you to be a parent or you’d get pregnant naturally.”
• “You’re playing God, don’t you think that’s disgusting?”
• “Everything happens for a reason, maybe you should just move on.”
• “Why don’t you just adopt?”
• “It’s so selfish to do IVF when so many kids need a home.”
• “It’ll happen naturally when you stop trying.”
• “I have two kids at home, do you want them instead?”
• “Is it your fault or his that you can’t have kids?”
• “So and so adopted and then got pregnant naturally, so you should try that.”
• “Why don’t you just get a surrogate?”

Another statement to avoid is to tell a person to “just relax,” says Dr. Holley. “The ‘conventional’ wisdom that’s out there about stress and fertility is that if you’re stressed out, IVF isn’t going to work,” Dr. Holley explains. “The data doesn’t support this. It’s not the person’s level of stress that will dictate the outcome.”

You might also have concerns about announcing a pregnancy to someone going through IVF or another family-building treatment, says Linda Hammer Burns, PhD, a licensed psychologist and associate professor at the University of Minnesota Medical School. She recommends speaking to the friend one-on-one before making a big announcement or inviting them to a baby shower. This will give them a chance to process their feelings without an audience. Then, it’s important to have compassion (and try not to take it personally) if they choose not to attend your baby shower or another event.

What to do if you’re worried about a friend on their IVF journey

Going through ART or IVF is stressful. In fact, an estimated 23 percent of people experience anxiety, and 17 percent experience depression, when going through family-building treatments. If you notice a loved one seems very withdrawn or their day-to-day functioning is affected, you may feel like you should say something to your friend. Doing so can be understandably hard, and a lot of people shy away from saying anything because they aren’t sure how to address changes in their friends, says Dr. Burns.

“There’s no harm in bringing it up if you ask people questions in a way that is inviting and genuine,” Dr. Burns advises. “Say, ‘I’m going to say something now that might upset you, and I don’t want to do that, but I’m concerned.’”

Dr. Burns says to consider the environment—choose someplace quiet where you actually have time to talk with your loved one. Note that a family dinner or business lunch isn’t usually the right time.

“Be persistent. Say ‘I know you might not want to talk about it now, but I am concerned, and I’m going to remain worried until we do talk,’” Dr. Burns recommends. “When you get a message from a person like that, they’re often more willing to talk to you.”

If you feel your friend needs professional help, you can ask them if they can talk to their doctor, including their primary care doctor or a doctor at a reproductive clinic. Dr. Burns also encourages concerned friends to visit helpful resources, including RESOLVE.org, the website of The National Infertility Association, and the American Society of Reproductive Medicine. No matter how you ultimately decide to support a friend going through IVF, the simple fact that you are considering their feelings during this sensitive time is a good first step.