Many young men and women of marriageable age assume that when a couple decides it is time to start a family, it is simple to conceive and bring a healthy baby into the world. In fairness, they have good reason for making that assumption. Growing up they attend brises and baby-namings and they witness the growing families around them. Children are a central focus of Jewish life and living, and young people understandably assume that having them is fairly easy and straightforward.

But they are wrong. What they don’t hear about, because we don’t talk about it, are those suffering and struggling in silence and privacy, desperate to bring a baby into the world and eager to become a mother and father for the first time, or once again. There are more than seven million people of childbearing age in the United States currently struggling with infertility. Up to 20% of those who do become pregnant experience a miscarriage. Eighty percent of those miscarriages occur within the first trimester when the couple is unlikely to have told anyone they were expecting.

Infertility and the pain associated with it are unfortunately nothing new. Our matriarchs and patriarchs struggled with barrenness. Yitzchak was 40 when he got married and the Torah says he was 60 when Yaakov and Esav were born. Together, Yitchak and Rivkah suffered with infertility for 20 long years, praying, longing, and waiting to see the fulfillment of God’s promise to build a nation.

Rachel, too, knew the pain of childlessness. She screamed out in pain, “If I don’t have a child I am already dead,” from which the Talmud (Nedarim 64b) teaches that to live without children is to experience a form of death.

Resolve, the National Infertility Association, writes on its website:

Infertility can feel like a death, like a prolonged mourning process as dreams die and hopes are dashed… The pain is similar to the grief over losing a loved one, but it is unique because it is a recurring grief. When a loved one dies, he isn’t coming back. There is no hope that he will come back from the dead. You must work through the stages of grief, accept that you will never see this person again, and move on with your life.

The grief of infertility is not so cut and dry. Infertile people grieve the loss of the baby that they may never know. They grieve the loss of that baby who would have had mommy’s nose and daddy’s eyes. But, each month, there is the hope that maybe that baby will be conceived after all. No matter how hard they try to prepare themselves for bad news, they still hope that this month will be different. Then, the bad news comes again, and the grief washes over the infertile couple anew. This process happens month after month, year after year. It is like having a deep cut that keeps getting opened right when it starts to heal.

This week, I met with three women whom I don’t know and who themselves only know each other from attending an infertility support group. They came with difficult and complex questions in Jewish law about IVF, surrogacy, the use of gestational hosts, and Jewish status. I explained to them that I am far from an expert in these areas, but I am absolutely committed to researching their questions and helping them in every way that I can.

We then got into a discussion of the challenges of struggling with infertility and the acute pain, financial hardship, and intense loneliness that they have each felt. The women shared the often-prohibitive cost of treatments, with one of them having spent over half a million dollars and the others depleting their savings to cover bills totaling a quarter of a million dollars. Two of the women have babies as a result and I pray that the third will have her dreams of being a mother realized in the near future.

Those with infertility or who have suffered a miscarriage are often grieving without anyone even knowing.

A common theme of the agony they described was the loneliness of going through this hardship without the explicit knowledge, awareness, support, love, or assistance of others. Those with infertility or who have suffered a miscarriage are often grieving without anyone even knowing. They are forced to spend their days interacting with others as if all is well, when in fact it isn’t.

Worse than the indifference of friends and acquaintances these women described is the unintentional insensitivity of so many who have been blessed with healthy children and who make comments, tell stories, share pictures, or complain about their kids.

I walked away from the conversation pledging to myself and committed to encourage others to be better, more sensitive, and more aware of the comments and passing remarks we make at Shabbos tables, in shul, and on Facebook. If it were our son or daughter, or our brother or sister suffering with infertility, we would measure our words, think carefully about what we say, and anticipate the potential impact of all we do. When planning our simcha (celebration) we would think about how we could be sensitive to our loved one who may never be in a position to make a bar or bat mitzvah or a wedding.

Well, those suffering are our loved ones. They are our brothers and sisters and we must bring that level of vigilance and mindfulness to our behavior to ensure that we don’t even unintentionally contribute or compound their already unbearable pain. When hosting a simcha or sharing about our children or grandchildren, minimally, we should always reference how fortunate and blessed we feel, that we don’t take it for granted and that we pray for those who don’t have children.

Resolve has a helpful page on its website called infertility etiquette in which they remind us not to be nosy, ask inappropriate questions, make assumptions, gossip, or minimize someone’s challenge. Instead, they say “The best thing you can do is let your infertile friends know that you care. Send them cards. Let them cry on your shoulder. If they are religious, let them know you are praying for them. Offer the same support you would offer a friend who has lost a loved one. Just knowing they can count on you to be there for them lightens the load and lets them know that they aren’t going through this alone.”

Our matriarchs and patriarchs ultimately saw their dreams fulfilled and we are here today as a result. May all those yearning for healthy children see their hopes and aspirations come true and may we all get only yiddishe nachas from the children whom we are so blessed and fortunate to have.