November/December 2012 Issue

The Impact of Infertility
By Lindsey Getz
Social Work Today
Vol. 12 No. 6 P. 30

When a woman cannot bear children, it tremendously affects her identity, but the pain can extend far beyond her to impact personal relationships.

Although there is a large body of research addressing the emotional impact of infertility while a woman is actively undergoing treatment, the aftermath of infertility is almost never addressed. In fact, Marni Rosner, DSW, LCSW, a New York City-based psychotherapist, found that as of 2007, only 2% of research examined the postinfertile period.

In her study, “Recovery From Traumatic Loss: A Study of Women Living Without Children After Infertility,” conducted at the University of Pennsylvania’s School of Social Policy and Practice, Rosner explored how women living without children after infertility rebuilt their identity and their life. Of the sparse research that addressed the aftermath of infertility, she found that most focused on women who had eventually become parents. But it’s the women who don’t have children who need special attention, as the impact of infertility for this population is often ongoing and crippling to their identity.

Although there are infertility support groups available, women who choose to remain childless may feel isolated even if involved in such organizations. That’s because these groups focus on options such as in-vitro fertilization or adoption. There is not much support for women who choose to stop treatment or choose not to adopt. “For many women who decide to live without children after infertility, isolation is an ongoing issue,” Rosner says. “Friends become parents, and there is much less in common with them. Many of the women I interviewed spoke of knowing no other couples without children.”

Rosner says society’s reaction to the trauma of infertility contributes to the isolation. “Most people understand how awful and against nature it is for a parent to lose a child,” she says. “But infertility is not understood in that way—although the trauma is quite similar. It is the death of one’s anticipated and imagined life and has great psychological repercussions. Education in this area—both for clinicians and the public—is critical.”

Impact on Self
A key finding from Rosner’s research is the fact that infertility can have a profound impact on identity. “First and most obviously, there is the disruption to the expected developmental shift to parenthood,” Rosner says. “Women often begin to imagine themselves as mothers long before actually trying to have children, and this is certainly influenced by implicit cultural and societal messages that idealize motherhood. When this imagined self of a mother, however tentative, is withdrawn, it may result in feeling a loss of control, threaten her imagined future, cause her to doubt her womanhood, and feel like an assault on her ability to self-actualize.”

Pregnant peers and/or those who have small children often surround women in their childbearing years and can pose challenges to the infertile woman. “Parents often connect with each other and form friendships through their kids,” Rosner says. “Women also bond and deeply connect through what they have in common, which includes pregnancy and children. This may result in an infertile woman feeling marginalized or stigmatized because of her childlessness. She may also question where she fits in with her family of origin. There may be guilt about not being able to provide a grandchild or a feeling of not fitting in.”

Impact on Relationships
Almost all the women interviewed for Rosner’s study spoke of the stress that infertility placed on their marriages. “Yet this crisis also forced couples to engage in self-reflection, to be vulnerable, and to develop a deeper mutual empathy and appreciation for each other,” Rosner says. “It is truly an opportunity to foster tremendous emotional intimacy and commitment despite the painful ups and downs. Still, not everyone gets through infertility with their marriage intact. Conflict often arises over transitions—which treatment to use, when to stop treatment, or when to adopt.”

When couples cannot agree on these important decisions, it is often due to an issue that existed prior to the infertility. “A social worker can explore with the couple whether there are underlying issues that prevent them from reaching a decision that is best for the relationship,” Rosner says.

Infertility also can impact a woman’s relationship with other family members, though overall, Rosner did not see tremendous shifts in long-existing family patterns. Still, even in a strong family dynamic, the infertile woman may experience painful changes. For instance, the woman’s parents may give more attention to her siblings with children or the infertile woman may now be out of sync with siblings as developmental stages are no longer shared.

Though family relationships didn’t change dramatically, Rosner did see significant shifts in friendships. “Many women experienced a lack of empathy and support, and insensitivity from close friends,” she says. “This disenfranchised grief resulted in strained or broken friendships and was extremely painful.”

The Social Worker’s Role
There are several emotional triggers for infertile women. It’s hard to go out in public without constantly seeing mothers and children, Rosner notes. “We live in an incredibly pronatal society, and the emphasis on families with children is everywhere—commercials, TV shows, and movies, for instance,” she says. “A woman of childbearing age is often bombarded with reminders that she is not a ‘member of the club.’ The feelings are quite complex and often include tremendous envy, which can contribute to depression.”

Social workers have the opportunity to focus on normalizing, validating, and educating the infertile woman. “Women experiencing infertility often feel traumatized, crazy, and alone,” Rosner says. “Simply providing a safe ‘holding environment’ aids in reintegrating one’s sense of self, particularly considering the disruption to social supports and disenfranchised grief most experience. Clients often need ‘permission’ to avoid certain situations or events such as baby showers—and we can give that to them. We can also teach clients mindfulness meditation to help them manage when they are unable to avoid overwhelming situations.”

Social workers also need to recognize that infertile women who make the decision to stop treatment or not to adopt often continue to identify their infertility as the primary component of their “self” for quite some time. In Rosner’s study, she found that it took, on average, three to four years after ending treatment until the “feeling of being infertile” was no longer front and center.

“There is so much shame with infertility, which is compounded for those that were raised in an environment of shame, secrets, and/or unresolved childhood trauma,” Rosner says. “We can help women work through the trauma and shame of infertility so it doesn’t get ‘stuck’ in their bodies and minds by assisting them in developing a narrative around their infertility. This involves identifying all the losses—social, identity, ancillary—and helping clients articulate what the losses mean to them. This is fundamental in helping to integrate the loss into one’s life story.”

The social worker also can introduce themes of acceptance and choice, Rosner says. “We can instill hope by conveying that it is possible to live a good and rewarding life—although different than what was expected—without children.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.