The journey to starting a family can be very different for different people; and with an estimated one in six couples struggling to conceive, the road can be long, physically tough and emotionally distressing. It should come as no surprise really that it has an impact on work.
New research has found that 40% of workers trying to conceive have considered quitting their jobs because of it, almost a quarter (24%) have reduced their working hours or changed their working pattern to accommodate their journey to parenthood, and 17% had passed up an important career opportunity.
Furthermore, over half (53%) said they would take a pay cut to get better access to fertility support. The survey of 500 UK workers, by the British Infertility Counselling Service and digital health app Peppy (peppy.health), revealed the huge impact fertility struggles can have – with 60% saying it had negatively impacted their work and 50% saying it had led to burnout.
The problem is, fertility is such a personal, emotional issue and many don’t talk about it outside their immediate family – never mind to their boss. On the flip side, the majority of workplaces don’t have a culture that encourages employees to open up or offer any practical support for it. And naturally, employees may not want to share their future family plans for fear of being passed over for promotion or good work, either.
Francesca Steyn, director of fertility services at Peppy and chair of the Royal College of Nursing Fertility Nursing Forum, says: “It’s still one of the biggest taboos out there. There is a lot of shame and stigma and guilt, people feel like failures.”
What employees could be dealing with behind the scenes
There are two sides to any fertility journey: the physical and the emotional. Depending on how far down the line someone is, there can be a lot of appointments, investigations, perhaps miscarriages, IVF treatment, including daily injections, drugs and surgical procedures. “Then there’s the emotional turmoil, the trying to conceive, getting that negative test, getting your period or being diagnosed with a condition that means it’s impacting your fertility,” says Steyn.
Although the brunt of fertility treatment usually (but not always) falls on women, when couples access help, 50% will likely be affected by male factor fertility, she says, but even when they aren’t, “it very much affects the men too, watching their partners go through this, it takes its toll.”
For people in the LGBTQ+ community the road to becoming a parent can be especially tough. “It’s a minefield, the complexities around it. It takes a lot longer and the financial impact is huge,” explains Steyn. “It’s quite rare for people from that community to get NHS funded treatment. It’s rare for heterosexual [cis-gendered] couples to have funded treatment, the criteria is so strict, but for people from the LGBTQ+ community, it’s really tricky.”
Same sex female couples have to find a sperm donor and go through various procedures, same sex male couples have to find a donor egg and a surrogate. “Surrogacy journeys are lengthy – two to three years plus in the UK,” says Steyn. “There’s such a shortage of surrogates and of egg donors in this country.”
For someone trying to conceive without success or waiting for fertility treatment, going into work every day and “hearing other people in the office announce pregnancies and talking about their children can be difficult,” she notes.
The practicalities of IVF around work
In vitro fertilisation (IVF) can take up to eight weeks from start to finish. Steyn explains a patient will go through a series of medications to manipulate the menstrual cycle, “which could make you feel a bit PMT, groggy, a bit sad and stressed.” Then there’s a series of scans over a two week period to check if the drugs have worked and the womb lining is thin enough, followed by another scan, injections to stimulate the ovaries to respond, and up to five trips back to the clinic to check everything is on track over the next two weeks.
“Scans are normally in working hours, people often ask for their scans very early or in their lunchbreak or after work so they don’t have to tell,” she adds.
After that there’s an egg collection – a surgical produce requiring a whole day off because anaesthetic is used (“Some people might feel unwell, there might be some pain”) and a few days later, an embryo transfer – a procedure to put the embryo back into the womb.
This is followed by an agonising two-week wait to find out if the pregnancy has taken. “You can’t focus [on work],” Steyn says. “IVF doesn’t have a 100% success rate so if [the pregnancy test] is negative they have to go back to work, after going through all of that and still not getting the one thing they want.
“I’ve seen people who go back to work [after an IVF procedure] because they’re scared of telling their boss. They take a sick day or an annual leave day, or we’ve been asked to write a sick note (which doesn’t open up what’s been happening).”
How do we start the conversation?
If you’re going through a difficult time, it may help to let someone at work know what’s going on.
Dr Mridula Pore, co-founder of Peppy, says: “Whether you’re trying to conceive, going through fertility treatment, assessing your options or dealing with loss, talking to your employer can help you to better navigate that experience.” It’s a health issue after all, so you are entitled to bring it up in strict confidence.
“Sometimes one private, frank discussion with your line manager can be all it takes. Alternatively, HR should be able to point you towards any policies and support pathways the company has in place for employees going through their fertility journey.
“Not everyone feels empowered to talk so openly [though],” she acknowledges, so its up to workplaces to create a culture that encourages it. As a health issue, employers need to provide support that deals with the practicalities of fertility treatment (like time off to attend appointments and flexible working at particularly difficult times), “but also offer independent, personalised advice and emotional support”, says Pore. And employees need to feel safe and secure in their jobs, no matter what their family plans are.
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