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For Manaker, a 41-year-old dietitian based in Charleston, S.C., it was a time marked by constant doctor's appointments, medications, treatments and anxiety about what the future held.
The physical and emotional stress of trying to have a baby was compounded by her inability to partake in her usual social activities b ecause of fertility treatments and medication, she said. Dancing, grabbing drinks or attending exercise classes with friends were no longer things she could do or felt capable of doing. During that time, some of her friends were expecting babies or were new parents hosting birthday parties, baby showers and other child-focused events.
"It was hard to attend those things," Manaker said, "so I reached a point where I just didn't go."
At the time, she said, infertility was not something she felt she could talk openly about.
As a result of these factors, Manaker not only felt isolated and lonely, but also noticed many of her friendship dynamics changed: Certain friends would put pressure on her to go out and do things, she said, while others would get angry when she didn't share in detail her experiences with fertility treatments. Some friendships fizzled out.
"It was upsetting at the time, but it also felt a little bit like a relief because I already had so much pressure on my shoulders between my cycles with my doctor and trying to maintain my job and I couldn't handle anything else," Manaker said.
Other friendships, meanwhile, strengthened. She also had friends who "didn't make it about them and they were really there for me," according to Manaker.
These experiences are not necessarily unique. Many women going through infertility say they find it to be a lonely, isolating experience that takes a toll on all aspects of life - including friendships.
Although 12 percent of women in the United States between the ages of 15 and 44 have difficulty getting pregnant or carrying a pregnancy to term, the topic has long been considered taboo. For some women, that has meant friends or other loved ones don't know how to even broach the subject with them. Others have found it difficult to bridge gaps in understanding even when it is out in the open.
Regina Townsend, a 39-year-old from Chicago, said she lost friendships or experienced changes in relationships during her own struggles with infertility and reproductive health.
Townsend, who has polycystic ovary syndrome (PCOS), said she has experienced extremely long and painful periods that exhaust her. PCOS can also contribute to infertility, but a general lack of education and knowledge around reproductive health can perpetuate confusion among friends, according to Townsend.
One time, she said, she fell asleep while a friend was visiting, and her friend was "really offended." Townsend said she felt she couldn't explain that she felt like she was "bleeding to death and I'm exhausted and I'm not the same (person) right now."
She has also had friends who grew frustrated when she didn't want to talk about her fertility treatments, Townsend said. "I'm like, well, I can't handle your emotions while I'm trying to handle my emotions," she added. "I am traumatized by this. I can't keep up with you and what's going on with you while I'm over here trying to live."
These struggles ultimately led Townsend to create the Broken Brown Egg, an infertility advocacy blog focused on Black women's experiences. She is not the only one who, in the absence of connection with friends, went searching for community with others.
Risa Kerslake, 35, a nurse and freelance writer based in Minneapolis, found writing about her experience to be cathartic, so she started a blog. She said that through it, she has fostered an online community of people who understand her story and the intricacies of fertility treatments.
Kerslake relied on "in real life" friends to distract her from that part of her life and talk about other topics when they spent time together, she said.
Indeed, there are many blogs, social media communities, support groups and other resources for people struggling with infertility to get help.
Laura Spencer, 39, who lives in Vancouver, used her experience of feeling isolated and misunderstood during infertility to inform her career as a fertility coach. Spencer said on top of the stress of desperately wanting a child, she felt envious of friends who were on the "timeline" she wanted to be on. As a coach, she said, she aims to provide a safe place to vent, as well as be a source of knowledge for clients going through fertility treatments.
"It just makes it that much harder to maintain relationships when you're kind of feeling left behind because people are getting pregnant and having kids all around you and you're not," Spencer said. "You don't really know where you belong."
Feeling unsure of your identity while going through infertility can be amplified for Black women, Townsend said.
The lack of diversity in fertility treatment conversations and advertisements creates more isolation and confusion for Black women such as herself, she said, as if they're "a minority inside of a minority."
Townsend works to fill that gap through her work at the Broken Brown Egg. She also runs an online support group, and the organization's website has a list of resources to help people of color find the connection and support they might not be getting in their day-to-day lives during infertility.
"Infertility is bigger than babies," Townsend said. "It's your emotional health, your mental health, your financial stability, your relationship. There's all of these layers to it that you're navigating, and it feels terrifying because you're not sure what to do or where to go and who do I talk to?"
Both parties in a friendship can benefit from honest conversations and a willingness to listen to each other, experts say, because it can also be difficult for new or expecting mothers to navigate their relationships with friends struggling to get pregnant.
When Victoria Lamson, a 35-year-old freelance writer from San Francisco, became pregnant, her best friend was struggling to conceive. Her friend asked Lamson to check in with her before she wanted to bring up anything baby-related, which was, to Lamson, a difficult ask. "It's not so simple as 'Oh, I have this material thing. I have this purse that you don't have,'" Lamson said.
Lamson said she wishes she could have been more clear about what she needed from her friend - but that there's also a need for more support in general for pregnant or expecting parents.
"Society kind of looks at it as, 'Well you're the lucky one, so you can deal with it,'" Lamson said. "And that's how I felt, I was lucky, so I just had to feel unsupported and deal with whatever emotions my friend was dealing with and I just had to kind of silence myself."
But for Townsend, there are still small ways to show friends on different life paths compassion while respecting your own boundaries. Gentle communication with that friend can help - giving your friend going through fertility treatments a heads up before posting a pregnancy announcement on social media, for example.
"That's kindness in a way that I don't think we think about," Townsend said. "Because we think so much about, 'Well, that's taking away from my moment and I should be able to celebrate.' Yeah, (but) I don't want my happy news to make tragedy news for them. So let me just take some time and extend some care and let them know this is what's going on."
Miriam Kirmayer, a psychologist and friendship expert, said there are other practical ways someone can show up for a friend who is going through infertility treatments: offering rides to and from appointments, picking up medication and dropping off meals.
Friends should also avoid "toxic positivity," Kirmayer said. Phrases like "it'll all work out," or "it'll happen when you least expect it," or "just relax"- while often well intended - can make a struggling friend feel alienated or as if infertility is somehow their fault.
The onus or burden of getting care is not on the person going through a difficult time, Kirmayer and Spencer said. But if you are struggling with infertility, it is important to talk with your friends about how they can support you in an honest way. Be clear with your friends about what you need from them and try to be willing to be vulnerable about what you're experiencing.
And if a friendship is truly no longer adding value to your life, it is OK to re-evaluate and end that friendship. Townsend said that's what she learned during her infertility struggles - a sentiment Kirmayer supported.
As Townsend put it: "It's OK to acknowledge that sometimes things run their course and that once they run their course, you have to make a decision about what's in the best interest of you."
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