#FertilityAtWork - The impact of infertility on your career, and the challenges of combining fertility treatment and work

photo by  Gabriel Matula  on  Unsplash

[ piece originally published on Medium ]

This week is UK Fertility Week and today the theme is #FertilityAtWork

Infertility can affect every aspect of your life: physically, emotionally, romantically, financially, socially — professionally.

The impact of infertility on a woman’s career is often overlooked, and shouldn’t be underestimated.

(Both men and women suffer from infertility, and both men and women go through infertility treatment together as a couple: but it’s the female partner who experiences the physical side of treatment — as well as any subsequent pregnancy or pregnancy loss — therefore I’m focusing primarily on the impact of infertility on women in this instance).

We know infertility is really common — in the UK it’s 1 in 6 couples.

As is miscarriage — an estimated 1 in 4 pregnancies ends in miscarriage.

Really, really common. But how many people who’ve experienced this have done so in silence — not even telling friends, let alone work

It’s really really common and yet stigma and taboo and this only breeds further lack of understanding and sense of isolation.So this piece has two main goals:

1. Raise awareness and understanding of the emotional side

  • The challenges of combining treatment and work

  • The real problems that women have experienced throughout their infertility journey at work,

  • The very real impact of struggling with fertility problems on mental health

  • The very real negative consequences of an unsupportive employer — and the positive impact that a supportive workplace can have

2. Raise awareness and understanding of the practical side

  • Your employment rights during IVF

  • What employers can do to better support employees (and why this is good for everyone)

I hope that this piece helps to raise awareness and understanding of these issues, to empower you to advocate for better support at work — and most of all, to know that you are not alone.

The challenges of combining treatment and work shouldn’t be underestimated

Fertility Network UK conducted a survey in 2016 in conjunction with Middlesex University looking into the impact of fertility problems, which highlighted the extent of the problem:

  • Those most in danger of experiencing high levels of distress and suicidal feelings were those who had less support from friends and family andtheir employer.

  • The vast majority of respondents (85%) felt that having treatment affected their day-to-day work

  • 50% of respondents needed more than a week off work for a treatment cycle

  • Half felt concerned that treatment would affect their career prospects

  • A third felt their career was actually damaged as a result

  • 19% had to reduce their work hours or quit their job.

  • These concerns about work and career increased with more cycles of treatment

  • Yet only one quarter of respondents reported the existence of supportive workplace policy

  • Less than half received really good support from their employer(although 90% received at least some support).

  • 59% of respondents felt their employer would benefit from education/support to help them better understand the needs of someone having treatment

The problems fall into 3 key areas:

  • Direct impact of treatment in the workplace — day-to-day

  • Direct impact of treatment on your career — long-term

  • Indirect impact of long-term infertility on your mental health (& the knock on affect on your career)

I’ve received hundreds of contributions from real women sharing their own experiences — here are some of the stories behind these stats.

Direct impact of treatment in the workplace — day-to-day

Not feeling able to tell employer about treatment

Many women don’t disclose their treatment to their employer out of fear of being judged or penalised:

  • fear that employers won’t take their infertility seriously

  • fear that their confidentiality may be breached

  • fear that it will adversely affect their career prospects.

This then creates a vicious circle: women are reluctant to talk openly about going through infertility treatment because of a (perceived) lack of understanding of the issue — but keeping it secret only reinforces the stigma of infertility as a taboo subject.

Employers can only offer support if they know that an employee is going through treatment — but employees will continue to be reluctant to disclose unless they know they will be supported.

(Fertility Network UK / Middlesex University survey 2016)

In my previous role, my boss actually disclosed to another colleague that I was having IVF despite me having asked she keep it confidential — not very impressive considering she was the HR Director
I hid it for a long time, knowing full well that as soon as I came clean I wouldn’t be put up for promotion because they would assume I would be ‘fixed’ and go on maternity leave straight away.
I haven’t told my work we’re trying to get pregnant — as soon as they hear that they’re already thinking of the next person to do your job. And as I’ve had losses in the past, who knows how long it will be until I actually get to take maternity leave?
One of the reasons I haven’t told many people is because of how pregnant women are treated in the workplace — I don’t want to be ‘thought out of my job’. This started to happen just after I got married, like a colleague asking when I was going to go on maternity leave as her contract was about to run out.
Women who are going through this journey are private about the matter. It’s your shameful secret. Your mental health is massively affected.
I just wish it was a open discussion and a norm. I feel like it’s a dirty secret. Part of me dreams about talking openly to people but it’s like I open my mouth and I just can’t because I’m not supposed to tell.

Difficulty managing appointments with working hours & travel requirements

  • Lack of provision for fertility treatment in HR policy : IVF being considered elective & not afforded the same rights as other medical treatment

  • Inability to manage commitments of treatment and work over the longer term

Under my work’s policies IVF falls under elective procedures — which means holidays rather then medical leave
I think even the progressive employers’ fertility policies are unequal. If they don’t limit paid sick leave for other medical problems, why do they limit it for infertility which (as I’ve discovered from you) is classified as a disease? Since women go through most of the treatment, even if the problem is with their partner, this affects us disproportionately.
I left my career 2 years ago because I simply needed more time off to do treatment — it became impossible to manage trips to the clinic. I very much regret leaving a job that I loved.
I’ve actually put my career on hold for 2 years (& counting!) to try and make this work. I loved my job, I was good at it, but couldn’t do it at the same time as so much treatment. It’s a real killer of course when you have nothing to show at the end of it
I actually had to leave my career due to the stress that it put on me. The hours I would have to put in to take off one day were insane. I couldn’t imagine having to do IVF around the schedule I used to have.

Direct impact of treatment on your career — long-term

Impact on performance

  • One of these being that your performance is judged unfairly by employers on the basis of taking time off — ie it’s not your actual performance, it’s that your employers are penalising you for medical absence

  • But also the impact of stress and trauma on our day to day performance

  • This is a really really tricky one — you don’t want your employer to assume that you’re going to be unreliable, but sometimes you do really really struggle because of everything you’re going through.

  • However I also think that’s true of many many difficult things in life, and we do bring our whole selves to work — so any emotional trauma in anyone’s lives is going to have an impact.

  • We’re all human, we’re not robots, and everyone who’s going through a hard time deserves compassion and support.

Infertility and pregnancy lead me to my worst performance rating of 10 years service. I thought they were understanding about my circumstances but apparently not so much….and I work in HR!!
I have checked out. Infertility is so exhausting that it feels like a full time job in itself. I have been so distracted with tests, big decisions and picking myself back up after 2 back to back miscarriages last winter — without anyone at work having a clue. I know I haven’t been performing at my best but how do you explain why if challenged?

I feel a bit trapped and in total limbo…. I don’t feel I can tell work because I don’t want to be treated any differently in terms of being given new opportunities because I could be gone at any moment.
I feel that it has affected my mental health and this has affected my ability to really focus on my career, because I haven’t had the mental energy to think about my professional development.

I feel I am now in a position where I feel stuck — my recent appraisal showed I barely met any of my goals because of things going on in the last year, and I feel deflated because I don’t feel like I’ve achieved anything in my work recently.
I ended up leaving due to the stress, despite having an understanding boss the stress and depression really got to me and I felt I wasn’t performing properly — and so many other people around you just don’t get it.
Not enough understanding or support for my stress levels surrounding this, and massive anxiety — meaning I am signed off for the next month and have missed out on a promotion & lost credibility

Lack of career progression due to staying in a ‘safe’ job

Staying in unsatisfying roles due to:

  • not wanting to take on a more challenging role to avoid additional stress

  • not wanting to take on a more challenging role because of not feeling able to give 100% to the job

  • not wanting to leave an established role because of having built up trust with a boss or team, affording some leeway on flexible working

  • not wanting to leave an employer with a favourable IVF or flexible working policy, to facilitate having treatment

  • not wanting to leave an employer with a favourable maternity package, in the hope of getting pregnant

I don’t feel able to go for promotions or development opportunities, as I don’t know how the timing would work out, and I would be too worried about the pressure in a new role.
In all honesty it’s kept me in a job I’ve outgrown because they are very understanding and I’m worried if I move a new company wouldn’t be so accommodating. It definitely makes me feel stuck and a bit deflated at times
I feel it has halted me moving on anywhere for years…I am stuck in a job I don’t like as we need money to pay for treatment, and they’ve been flexible with appointments
The benefits and flexibility, and the social capital I’ve accumulated will keep me at my current job for now. No one at work knows, but we have flexitime so I can come and go and take time off whenever I need no questions asked.
I have stayed still for 3 years now, “just in case” I get pregnant that moment I hand my notice in and lose my maternity benefits. I have not gone for any training/qualifications because we may need that cash for private treatments. With everything else going on, I don’t feel I have the energy to start anything new work-wise and cope with that stress.
My career stalled as I stayed in a job I hated initially because of maternity benefits (that reason didn’t last long!), then because of having fertility investigations and treatment, not feeling able to ask a new employer for time off work for IVF.
My career has been on hold as I’ve let opportunities pass by because “I might get pregnant”.

I feel like I’ve constantly got big heavy rocks in my stomach. The sadness physically hurts at times. But on the outside I appear happy.
I’ve stayed in a job and living somewhere that I want to leave, because the job offers a good wage, and the area I currently live offers more IVF cycles than the area that we want to move to.

I definitely feel like a failure career wise, which doesn’t help when you are also failing at starting a family — but ultimately it’s better the devil you know
I have changed jobs away from a career I loved but was stressful — I know my new job is less well respected and people think I’ve given up but it’s too late now.

Indirect impact of long-term infertility on your mental health (& the knock on affect on your career)

  • This is not just a bad day! This is life trauma, life-changing stuff, the impact on mental health is enormous and needs to be recognised as such

  • Severe levels of stress — being signed off sick, diagnoses of clinical depression and anxiety, mental health, losing jobs in the process

  • Understanding for the impact of ALL mental health issues is needed —it’s a huge issue

It has crushed me to my core. I struggle with bouts of anxiety and depression — infertility has actually changed my personality forever.

I believe the massive failure to achieve the one thing I’ve wanted most in life has eaten at my sense of self. I’ve become a chronically depressed fatalist.
I wish people could understand the sheer scale of the grief when you are unable to have a child.

I think many people don’t get it because they can’t understand how you can grieve for something you never had
I was told on numerous occasions that I should be grateful I wasn’t physically ill, yet people understand what a physical illness means (the fears, the treatment needed etc).

Also, with a physical illness there is usually a treatment plan which often leads to the illness disappearing and the problem being “fixed”. That is often not the case for infertility.
I think most employers see fertility treatment as something that’s a bit stressful and that entails you being ‘fixed’ and getting pregnant quickly.

There isn’t any understanding of the real trauma it can involve and how long you might be in treatment for.
I am not the person I was. I have sacrificed my career, my social life, my hobbies, my family life.
Infertility is my identity now.

I hope one day to be out the other side. But I won’t be the person I was. I don’t know who that person will be
I lost my career because of it. Juggling appointments in an already stressful profession lead to severe depression and suicidal thoughts.

My employer had no idea how to support me (and no idea what I was really going through). They didn’t fight to help me. No one did. I had to be my own advocate.

Honestly, infertility ruined my life.
It has affected everything. Every single aspect of my life. My career. How my employer views me. How I view myself. My mental health. My finances.

Things I thought I knew 5 years ago have turned out to be unreliable. It has undermined my sense of myself, and rewritten it on shakier ground.
I feel I have completely lost my identity because of my infertility struggle.

I don’t even know who I am anymore. I used to be a strong, confident, career-focussed go-getter who could take on any challenge. A high achiever throughout my whole life - I now sometimes find it hard to leave the house.

I thought having a baby would be the making of me and anything else I would ever achieve would come second - so now, despite having a successful director level career, my successes as a human being don’t hold any value for me.

However some employers are very supportive

Shout out to the brilliant bosses and exceptional employers — making a really difficult time that much easier.

Remember, happy and well supported employees are productive employees who perform better!

My employer and colleagues were probably as good as it gets with infertility. They all supported and protected me. Paid bereavement/medical leave after my losses would have been amazing however — I took 2 weeks off unpaid for each of my losses.
I work in an office so on one side my work has been fantastic: I have told my team and Manager, and they have been incredibly supportive.
My manager had 4 miscarriages and 4 IVF rounds so totally gets it — she has allowed me flexible hours so I can attend all my appointments.

After my miscarriages I had enough sick leave, but it would have been nice to have been proactively told that I could use bereavement leave as well, as that didn’t occur to me.
By telling my colleagues I felt able to take things slower especially after the miscarriage, and they understood why I was a bit grumpy and weepy.
I have a very supportive boss and team and get five days paid IVF leave a year

We can “buy” extra holidays so I’ll be doing to help with time off next year when our treatment starts
I have a job that involves constant travel — luckily my line managers have been fantastically supportive, but for how long?
I’m lucky in that my manager has been really supportive so appointments have never been a problem, and I’ve been able to talk to him openly about feeling terrible at times.

Now onto some of the more practical stuff — what are you entitled to, and what more could employers do?

Your employment rights during IVF

  • There is no automatic legal right to time off for infertility investigations or treatment

  • Relatively few employers have formal policies in place to support people having treatment.

  • Time off for medical appointments related to fertility should be treated in the same way as any other medical appointment

  • However fertility investigations and treatment are largely considered to be elective in the eyes of the law — leaving employees with no choice but to take either sick leave or annual leave

  • You are legally considered to be pregnant after embryo transfer (but not before), and entitled to the same protection from unfavourable treatment

  • If the cycle is unsuccessful the protected period extends for 2 weeks after the negative test result

  • If the cycle is successful but you miscarry the protected period extends for 2 weeks after the end of the pregnancy

  • You have the right to take sick leave if you’re signed off by the GP

  • Frequent requests for time off (particularly if unexplained) can lead to an employer triggering disciplinary procedures

  • If you are dismissed or treated unfairly because of IVF, you can’t make a claim for pregnancy and maternity discrimination but may be able to make a sex discrimination claim

What could employers do to better support employees?

Paid Leave

HR Magazine recommends this in their advice for employers about IVF do’s and don’ts

The employee will probably need time off for a number of medical appointments prior to conception.

Generally employers are encouraged to view time off for IVF sympathetically and in a similar fashion to antenatal appointments.

Women undergoing IVF are often advised to take it easy to help conception. This may mean that they ask to work fewer hours or reduce their responsibilities. Employers will need to assess this on a case-by-case basis and decide what is fair.

Where the impact of such a request can be managed easily and is for a short period of time, the advice is to agree to it

Have a defined fertility policy

HR Magazine has some clear suggestions in their advice for employers about what a policy should cover:

Have a policy that covers IVF. Such policies are rare but should be part of your staff handbook.

It should cover notification, time off pre-conception, requests to reduce hours/duties, counselling, sickness absence for reasons relating to IVF and how this sits within the overall sickness policy, unsuccessful attempts to conceive and/or miscarriage, and rights of fathers during IVF.

And guidance for employers to better understand the issue

The Fertility Network report says

Workplace policy for fertility treatment is needed and this should be combined with guidance to support employers who may have limited understanding of the needs of someone having treatment

Flexibility, Flexibility, Flexibility

Advice from a fellow instagram warrior, suggesting some practical things employers could do to better support employees:

Offer flexi-time to allow people to attend appointments

Offer employer-funded counselling

Offer flexible working arrangements where possible, or working from home on days when you are not emotionally able to go into the office but are capable of working

Offer temporary flexible work arrangements — e.g. going down to .8FTE during the two-week wait, or reducing hours during periods of high anxiety (ie first trimester for those that have had miscarriages)

More flexible development and progression opportunities that take into account timing difficulties.

I think that being more flexible about allowing time off for dealing with trauma is better for them in the long run than forcing you to work when you’re not ready and can’t afford not to — it could mean severely damaging your mental health and needing even more time off.

This isn’t just good for employees, it’s good for employers too

The Fertility Network report says

An understanding employer can make all the difference to an employee during fertility treatment.

Those who have adopted such policies say employees have responded very positively and responsibly.

They have found it generates goodwill which helps foster a happy workforce, and this in turn improves productivity and builds good customer relations

Which HR magazine agrees with

Having such a defined workplace policy for IVF is likely to attract and retain women generally as it denotes a family-friendly employer

Happy workforce = productive workforce = everybody wins.