The Department for Health and Social Care (DHSC) launched a call for evidence in March 2021 to inform the first ever government-led Women’s Health Strategy for England. This included questions around the potential role of employers, and the results have recently been published. In respect to fertility issues, it says: “Organisations flagged that many employers and workplaces do not recognise infertility as a genuine medical issue, and the physical, mental, emotional and financial strain that can be caused by fertility problems. This can leave women fearful that they will be discriminated against (for example, overlooked for promotion) if they are open about wanting to start a family.”
Similar concerns have been flagged by MP Nickie Aiken, who is campaigning for legislative protections and entitlements via a Private Members Bill. To date, there has been limited academic research on the intersection of fertility issues and employment to inform evidence-based organisational intervention. It is perhaps unsurprising therefore that the CIPD and Simplyhealth’s 2022 Health and wellbeing at work report showed increased employer interest in providing tailored health and wellbeing supports for ‘specific issues and groups of employees’, but that specific support for fertility treatment was bottom of the list (alongside support for menstruation).
Infertility and fertility treatment
According to sources such as Fertility Network UK and the NHS, as many as one in six couples experience infertility. Infertility can be caused by a medical issue but can also be ‘contingent’ or due to circumstance – such as sexual orientation or lack of a partner. Many individuals struggling to conceive turn to fertility treatment. Common forms of fertility treatment include medication; intrauterine insemination (IUI); in-vitro fertilisation (IVF); and frozen embryo transfer/replacement (FET/FER). There are also options including egg freezing. Access to funded treatment on the NHS is variable (with conditions attached linked to things like maternal age and Body Mass Index, as well as a ‘postcode lottery’) and many people end up spending thousands of pounds on private treatment.
We interviewed 80 women and men with direct experience of navigating a ‘complex fertility journey’ alongside employment. We asked them to tell us their story, including the challenges that they faced, and the support they received at work. The definition of complex fertility journey was intentionally loose, but most participants discussed fertility tests and treatments, and many mentioned miscarriage, secondary infertility and/or coming to terms with involuntary childlessness as part of their story. Participants were varied in terms of demographics (gender, age, relationship status, sexual orientation), stage in their fertility journey (and outcome of their journey), and importantly, employment context. We also conducted supplementary interviews with line managers (individuals with experience supporting an employee through fertility treatment) and fertility counsellors to gain their perspectives, as well as conducting a review of online materials.
Headline findings: individual experience
There is considerable (reproductive) work involved in navigating a highly individualised and unpredictable complex fertility journey, including researching conditions and treatments; following health and lifestyle advice; arranging treatments; attending appointments; and attending to the emotional demands of the process. It is very hard to balance this work with the demands of paid employment. Challenges were varied, including logistical, physical, emotional, social and financial.
The most widely acknowledged challenge is logistical – working out how to attend clinic appointments, which can sometimes be daily at certain points during treatment and are often arranged at very short notice because they are linked to menstrual cycle timings. This was especially challenging where an employee had little flexibility over their schedule and/or had to spend a lot of time sorting cover. Having said this, where an employee does have flexibility, one disadvantage can be a need to ‘make the time back’ – often by working in the evenings and weekends, when rest is needed.
Other challenges included finding a private space at work to inject medications or take important phone calls from the clinic; managing physical side effects and emotions at work; and dealing with triggers in the workplace, such as pregnant colleagues or working with pregnant women and children professionally.
While not the whole story, the extent to which someone feels able to disclose their experience at work, and the way their manager, HR and colleagues respond, often makes a significant (negative or positive) difference to their experience. Many people tried to manage their fertility treatment experiences on their own, which often proved difficult and added to their stress at this challenging time.
There was evidence of ‘identity threat’ (feelings of failure linked to fertility challenges) in our data, which coupled with logistical and emotional demands, and concerns about career consequences, led some people to change their career plans (avoid promotions or change paths), move to part time or even leave their jobs.
People also made work decisions based on the financial implications of fertility journeys – displaying presenteeism and/or missing fertility appointments (especially where their partner was the patient) to avoid losing pay or due to fear of compromising the chance of permanent employment; taking on extra work/hours; applying for certain jobs; or staying in certain jobs when they would rather not.
Headline findings: organisational context
Whilst most organisations recognise the need to take active steps to accommodate employee pregnancy, maternity and parenting needs, few organisations appear to have provisions for fertility treatment, and where they do, organisational policy and HR responses are often not sufficiently nuanced to be helpful or prevent discrimination. Policies can be constraining, can overlook the needs of certain staff, and can overlook certain experiences (such as coming to terms with involuntary childlessness as the outcome of a complex fertility journey).
Line managers are crucial to the provision of appropriate support, but managers often lack training, guidance or autonomy. The most effective managers were those who facilitated reasonable adjustments and found a way to reconcile this with systems/paperwork. They were also aware of their limitations, and where they needed more guidance/information.
Managers are tasked with balancing the needs of the employee with the needs of their team (who may be unaware of the issue), the needs of the business, and their own wellbeing. Some managers reported stress, upset, feelings of powerlessness, and/or extra work when dealing with this issue. They also reported uncertainty over how long reasonable adjustments/time off could be provided if an employee needed multiple cycles of fertility treatment. There were issues in managing a team which included pregnant/new parent colleagues.
Currently there is little in the way of legislative protection for those navigating complex fertility journeys alongside work, but we hope that more and more employers will offer tailored support around fertility treatment, pregnancy loss and involuntary childlessness.
The full report on the research, which was funded by The Leverhulme Trust, is available on the MMU research project webpage, and also contains recommendations for employers.
Dr Krystal Wilkinson is a senior lecturer in HRM at Manchester Metropolitan University