PHILADELPHIA –- For a woman who is unable to bear children, the pain of infertility extends far into her everyday life and can impact her relationships with family and friends for years.

Marni Rosner, who earned a doctorate in social work at the University of Pennsylvania in May, studied how infertility impacts female identity in her dissertation, “Recovery From Traumatic Loss: A Study of Women Living Without Children After Infertility.”

“I was curious as to how women living without children after infertility rebuilt their identity and life after this traumatic loss,” Rosner says. “There was little research that focused specifically on the long-term adjustment of women who experienced infertility and had not gone on to become parents either through biology, adoption or third-party reproduction. 

“There was really no other research that focused solely on this population in this era, with numerous reproductive options and so many life choices available for women.”

Rosner, 46, lives and works in Manhattan, where she established her own private psychotherapy practice in 2000.  She says that, while there is a great deal of existing research that addresses the psychological impact of infertility for women who are actively experiencing it, almost none examined the post-treatment phase.

Women are frequently asked if they have children or when they plan to have children, but the impact of such questioning for a woman who is struggling with infertility can produce a profound feeling of social exclusion, which can be brief or prolonged, Rosner says.  

“Stigma, in its everyday subtlety, manifests both interpersonally and relationally, deepens suffering and ultimately serves to become internalized as part of the woman’s identity.”

According to Rosner, society is extremely pro-natal, and families with children are the considered the norm.  Adults, once they become parents, link with each other and form bonds and friendships through their children, and their social lives are often structured around these friendships.

Rosner’s research shows that infertility often goes hand-in-hand with unacknowledged, or disenfranchised, grief.  In addition, relationships with spouses, friends and family members are impacted in some way.

“It is, essentially, an assault to a woman’s identity,” she says. “Although most women are forever changed by the infertility experience, many issues begin to resolve once you have a child. For those who decide not to have children after ceasing treatment, this issue –- this assault to identity -- remains very much alive.”

In her study done at Penn’s School of Social Policy and Practice, Rosner uncovered the losses created by infertility, including the denial of motherhood as a rite of passage; the loss of one’s anticipated and imagined life; feeling a loss of control over one’s life; doubting one’s womanhood; changed and sometimes lost friendships; and, for many, the loss of one’s religious environment as a support system. 

Rosner examined the years-long psychological process of infertility, from becoming aware of one’s inability to conceive through beginning and ultimately ending treatment and, finally, the process of letting go of hope and coming to terms with childlessness. She found that the women’s ability to fully acknowledge, grieve and integrate, rather than disavow, the numerous losses of infertility into their life story facilitated personal growth, what Rosner refers to as “post-traumatic growth.”

“Over time, most of the women in the study reported tremendous post-traumatic growth,” Rosner says. “Several ongoing issues remain, of course, but most participants had integrated the loss into their narratives, had actively reimagined their lives and were embracing life once again.”

The study found that on average it took three to four years for study participants to fully emerge from feeling like infertility was their primary identity.