Having difficulty conceiving can be emotionally draining for you and your partner. Generally speaking, if you have tried for a year without any luck, you should start looking for the reasons. About 50 per cent of women who have difficulty do conceive eventually. Infertility has doubled since the 1970s, and about 10 to 15 per cent of couples now cannot conceive without help. Factors in the man, in the woman, or in both can be responsible. The investigations into the reasons are lengthy and difficult and can interfere with your enjoyment of sex. You may lose heart about ever having a child, and may find yourself avoiding family and friends with children as a result.

Treatments for infertility are covered by the NHS to a limited degree as assessed on an individual basis. If your hormone levels are not high enough, you may be given steroids that can affect your mood. The next stages of treat­ment, through artificial insemination or fertilizing the eggs outside the uterus, can be very frustrating as well, demanding time as well as money, and the chances of success are only about 20 per cent at best.

If these techniques also fail, you may decide to adopt. You then have to be screened by an adoption counsellor, to try to make certain you would be good parents. Lately, fewer newborns have been available – single mothers have been keeping their babies, as the social stigma has lessened – so if you are seeking an infant you may have to go to orphanages in Russia, Romania, China or South America. The costs of travelling and legal and bureaucratic expenses can be very high. All in all, the financial and emotional complexities for you and your partner can cause great distress, especially if one of you would just as soon remain childless.

Even if you do adopt, you may still grieve for a natural child of your own. If you badly wanted children, not having your own child can be a major loss. Moreover, relatives and friends may never accept the adopted child as part of the family. Any of these factors can lead to depression in you or your partner.

Maggie and James had married in their late thirties. They very much wanted a child. Unfortunately, Maggie had severe endometriosis that caused excruciating pain during her periods. She had had an operation and had been placed on hormones to control the pain. She was unable to conceive. She had a history of depression, and her inability to conceive and the effects of the hormone made her depression worse. James started to worry that she would never pull out of it.

They talked to the gynaecologist, who finally stopped the medication; Maggie used painkillers during her periods instead. She gradually started to feel less depressed, but was still devastated at being unable to have a baby. She and James found out all they could about adopting overseas, because they were unable to arrange a local adoption. After many frustrating delays, heavy costs and bureaucratic tangles, James and Maggie adopted a little girl from China.

The next year was also stressful, as the child adapted slowly and they often worried about her physical and mental health. Fortunately, everything turned out well. After a year of devoted parenting, James and Maggie had a delightful, happy little girl who was curious and affectionate. But for many couples, this expensive solution is not an option.