Dear Amy: My college best friend is struggling with infertility and is near the end of the road with multiple rounds of unsuccessful IVF.

I’ve been there to support her through this, even though we live far from each other. My heart aches for her.

I have had two children during the course of her fertility struggles.

I have taken great pains to break the pregnancies to her gently, privately, and early, but I know it has been difficult for her.

I have been as tender as possible in sharing about my family life. (Neither my partner nor I use social media. I am a very private person).

As time has gone on and the medical interventions have ratcheted up, I can feel my friend withdrawing from me.

For example, during this most recent round of my friend’s IVF, she requested of our text thread of close friends: “no pictures of little ones, please.”

I’m the only one of us with kids, so I imagine this comment was directed with me in mind, even though I don’t think I’ve ever shared a picture on the thread.

I am feeling quite distant from my dear old friend at this point.

When we catch up on the phone, even answering the most innocent questions opens up this painful topic of my children.

I truly want to honor her feelings and the hardship she has faced, but the truth is that my kids are the most central and important thing in my life right now.

It feels strange and strained to avoid references to my family when we interact. I am struggling to know whether authentic friendship is possible here.

Any advice?

– Old Friend

Dear Old Friend: Your friend’s extreme fertility challenges will likely impact all of her relationships (not just yours), and because this issue threatens your friendship, I think you should attempt to talk this through – in as frank and honest a way as you are able.

In the course of this conversation, you might ask her if she is willing (or able) to form any relationship with your children. She is a special person in your life; could they be in her life, too?

She might respond that this is simply too painful for her. Ask her to draw the parameters about what she is able to discuss with you; if she insists that she cannot tolerate any mention of your children, it means that you can only discuss the central aspect of her life – and not yours. You can no longer be intimate friends, which is another casualty of her fertility struggle.

You can email Amy Dickinson at [email protected] or send a letter to Ask Amy, P.O. Box 194, Freeville, NY 13068.