How might fertility treatment affect the wellbeing of your staff?
Reader (Associate Professor) in Human Resource Management at Manchester Metropolitan University
Infertility can have a huge impact on your life – one so powerful, in fact, that some have compared it to a cancer diagnosis. It can lead to feelings of shame, deviance from the norm, or failure – and can leave people feeling depressed, anxious, or even having suicidal thoughts. It can cause stress in relationships, and leave you worried about how you’re going to proceed – for example, if you want to try becoming a parent in another way, such as looking into adoption, or trying fertility treatments.
Cycles of hope and grief
When you or someone in your workplace is undergoing fertility treatment, it’s a good idea to understand what that might look like.
There are a number of different medical treatments to address infertility, ranging from courses of medication; interventions such as intra-uterine insemination (IUI); through to more invasive protocols such as in-vitro fertilisation (IVF), egg-freezing, and Intracytoplasmic sperm injection (ICSI). These address female infertility, male infertility, infertility linked to circumstance, and fertility preservation.
Protocols such as IVF are linked to the woman’s menstrual cycle, which can make appointments unpredictable, and medication can invoke ‘mini-menopauseThe menopause at work: guidance for people professionals The menopause can affect performance and attendance at work. CIPD have put together a web page to help HR staff and leaders to understand the menopause, their legal responsibilities around it, and advice on creating a menopause policy in your workplace. By: CIPD View resource’ and other side effects. Success rates are low, meaning many people need to have multiple cycles, and can still end up childless. There are clear psychological tolls. Reference has been made to an ‘emotional rollercoaster’ and ‘cycles of hope and grief’.
Access to fertility treatment on the NHS is limited by postcode, maternal age and BMI, and other factors. This means that many people have to turn to private treatment, which can cost tens of thousands of poundsFinancial wellbeing COVID-19 has brought unexpected financial challenges to many households. If you're worried your employees may be struggling this guide can help. By: NHS England and NHS Improvement View resource.
There can be a lot of work involved in researching conditions, treatment options, clinic offerings; there may be strict health/lifestyle advice to adhere to, and/or surgery to address underlying conditions; daily medication (often painful self-administered injections); frequent (sometimes daily) clinic appointments for blood tests and scans; and an anxious period between treatment and pregnancy test (sometimes termed the ‘two week wait’ in IVF cycles) where there are often daily updates from the clinic about the progress of embryos.
Many people are reluctant to talk about infertility
There is still a general silence about these issues in society. Many people are reluctant to talkConversations about painful subjects Trauma can overwhelm someone's ability to cope. This guide is designed to help NHS line managers encourage their staff open up about potentially traumatic things they have seen at work. By: NHS England and NHS Improvement View resource about infertility and fertility treatment, as they feel it is too private, taboo or even shameful. This can restrict the amount of psychological support available from friends and family. Some clinics offer counselling as part of packages, but coverage is variable. Many people turn to online forums and other forms of peer-support.
A key finding in our research was the hugely individualised and unpredictable nature of fertility journeys, and their intersection with work. So the specific impact on a person’s working life will likely depend on the cause of infertility; how it makes the person feel about themselves; whether fertility treatment is pursued, as well as the type, duration and outcome of treatment; and the occupational context.
Here are some of the ways that infertility and fertility treatment affect working life:
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- Identity issues can impact on attitude to work, confidence, decision-making,
- Ability to concentrateFocus This one-page PDF from Unilever explores ways of helping you to regain your focus, allowing you to give tasks your undivided attention. By: Unilever View resource at work,
- Ability to attend work (due to need at attend appointments; travel for appointments; grief/mental health reasons)
- Extra work in arranging cover for appointments,
- Working evenings and weekends to ‘catch up’ on work missed due to appointments,
- Ability to perform at work (linked to medication side effects, mental health reasons),
- Additional workplace needs (in terms of breaks/private places for phone calls and administering medication; access to a fridge for medication storage),
- Strained relationshipsDifficult work relations This page from Mind explores ways of managing difficult working relationships, either with colleagues or managers. It also includes a section on what to do if you're worried you're being bullied. By: Mind View resource at work, linked to disclosure,
- Avoidance of certain people/situations where you might feel triggered (i.e. pregnant colleagues),
- PresenteeismPresenteeism and the hidden costs of staff who are glued to their seats This news article from the Institute of Directors (IoD), in collaboration with Raconteur, discusses the issue of presenteeism and how it can be managed within an organisation. By: Institute of Directors View resource (attending work when you should really be on leave) due to concern about assumptions or career consequences,
- Job decision-making: staying in a job you don’t like for the stability/benefits; not going for a promotion; going part-time; changing jobs or even quitting work altogether, and/or
- Working extra hours or multiple jobs due to financial concerns/pressures. This can be seen especially in the partner of the ‘patient’.
Importantly, in our research, there could be different impacts at different points during a fertility journey. The extent that someone feels able to disclose fertility issues at work, and the supportiveness of the individual line manager, are often key factors in experience and impact on work.
Some people disclose fertility treatment simply because they are worried that their performance might suffer
So what can you do if you are an employer, and know a staff member at your organisation is undergoing fertility treatment?
If an individual discloses infertility or engagement with fertility treatment, you should listen to the individual to ascertain what their key concerns are, and what they need from work. Some people disclose fertility treatment simply because they are worried that their performance might suffer, and they don’t want their manager to think they aren’t capable. Other people disclose because they have specific needs in terms of time off for appointments.
Where an individual is undergoing fertility treatment, consider what temporary reasonable adjustmentsReasonable adjustments at work What's reasonable at work? Whether you're looking for work or are already employed, this guide has information on rights at work for people with a mental health problem. By: Rethink Mental Illness View resource to the job role might be possible – for example adjustments to working hours, work location and job duties. Have regular wellbeing chats, and revisit any adjustments regularly to ascertain if they are useful.
Be led by the individual in terms of how much they want to share about their fertility journey, and how to explain any schedule disruption within the team
Signpost the employee to any psychological support services offered by the employer (Employee Assistance ProgrammeEmployee Assistance Programmes (EAPs) – Supporting good work for UK employers? This report, published by The Work Foundation in association with the Employee Assistance Professionals Association, explains how Employee Assistance Programmes (EAPs) can be used by employers to seek help on both work and non-work related issues. By: The Work Foundation View resource, counselling) and to external services and charities. If the employee is undertaking any psychological treatment, provide time/space for this during the working day if needed
Watch out for work situations that might be triggering for the employee
You could also try to ensure the employee has someone they can talk to at work. You might want to explore the possibility of setting up a buddy scheme or staff networkSt Mungo’s Diversity Networks Networks are a great way of connecting staff who have similar experiences and backgrounds. At St Mungo's, there are several different groups offering support and advice. By: St Mungo’s View resource for peer-support. Mentoring or coaching might be considered, where an employee has lost confidence, or is reassessing priorities at the end of a complex fertility journey
And, watch out for work situations that might be triggering for the employee, and try to pre-warn them or agree ways for the employee to excuse themselves if they want to.
These tips refer to what employers can do at an individual level. More broadly, employers can raise awareness around infertility, fertility treatment, childlessness and associated issues such as pregnancy loss (marking awareness weeks, etc.) in the workplace. This can help show that this is a common experience, and you can consider developing bespoke policies and/or benefits. The topic can also be added to line manager training, so they are more confident in handling the issue in their teams.
There are also some things you should be careful not to do, like:
- Do not make judgements about fertility issues or decisions. We have heard examples of IVF being equated to a lifestyle choice or cosmetic surgery that shouldn’t require support from work; or people being worried that they will be judged (i.e. for trying for a child without a partner)
- Do not make assumptions about who fertility journeys affect (gender; sexual orientation; sexual identity; relationship status); how long fertility journeys might last; what challenges will arise; or what outcomes might be. We have heard examples of managers starting to plan for maternity cover for an employee who has just disclosed fertility treatment, which can be incredibly upsetting and worrying.
- Do not make assumptions about career commitment at this time, or interest in things like career progression or new projects
- Do not feel that disclosure of infertility or fertility treatment gives you the right to ask intrusive questions or demand progress updates. Be guided by the employee.
- Try not to make assumptions about what support someone needs without speaking to them, and/or seeking advice
- Do not act in a way that causes discrimination or disadvantage due to their fertility journey.
Know that you are not alone
If you are struggling with this issue personally, then know that you are not alone, and that there are many others going through the same thing. These issues are generally silenced, but this does not mean that you should not talk about them – at work or more broadly. There is no shame in seeking GP or other medical advice if you feel that the psychological tolls of infertility or fertility treatment are becoming too much. There are also lots of peer-support services available.
Whilst there is no obligation to tell anyone at work about your fertility journey, or any related mental health issues, disclosure might alleviate some worries and aid access to support or work adjustments. When considering whether or not to disclose, you might want to consider what you hope to gain out of disclosure. Is it some understanding should your work performance temporarily suffer; is it practical support (time off for treatment); is it psychological support? If you do not feel your immediate line manager is approachable, is there anyone else you could talk to, such as HR? How much are you comfortable sharing? Can you signpost your manager to some information about your specific fertility issue/treatment, if explaining it feels ‘too much’?
There are a number of organisations who provide information, advice, support and resources for individuals navigating different stages of complex fertility journeys. These include:
- NHS
- Fertility Network UK
- British Infertility Counselling Association (details of specialist counsellors)
- The Miscarriage Association
- World Childless Week
- Gateway women
Dr Krystal Wilkinson is a Senior Lecturer in HRM at Manchester Metropolitan University. The research was funded by The Leverhulme Trust.
