By Serena G. Sohrab and Nada Basir
It’s 7:00 in the morning, and the nurse struggles to find Sarah’s vein to take her blood. Sarah’s arms are bruised; she’s been coming to the clinic for nine days in a row for morning bloodwork. She’s in the fourth year of her treatment and has no idea when it will end.
Sarah doesn’t have cancer or terminal illness — she’s trying to have a baby. When she started her treatment, she expected it to work quickly. She didn’t feel comfortable telling her boss, was careful not to overload herself with stressful work, and didn’t apply when a better position opened up in her department; she was focused on her care.
Sarah’s case is no exception. A growing number of couples are experiencing infertility, with around one in six seeking treatment. Despite this, most companies’ policies and initiatives focus on those who have had success in their family-planning journeys and on issues like duration of parental leave, post-leave integration, and work-life balance. While pregnancy and childbirth are highly visible and often celebrated, fertility challenges tend to be invisible and silent. For many couples, it’s an incredibly personal and sometimes painful experience, and one that’s difficult to share even with close friends and family. Discussing it with coworkers and bosses can feel like a window into the most intimate parts of your life. (As Carolynn Dubé from Fertility Matters puts it, “Infertility takes people into the bedroom.”)
Many women hesitate to share their infertility struggles because of concerns about its impact on their careers. According to a survey from Fertility Network UK, 50% of women did not disclose their treatment to their employer out of fear that the employer wouldn’t take them seriously and over 40% due to concerns about its negative affects on their career prospects.
Lengthy fertility treatments can have serious emotional, physical, and financial impacts on a woman and her partner. There are several actions leaders can take to understand these impacts and to foster an environment of support and inclusion. Organizations that enable employees to prosper in their careers through various life chapters will be able to attract and retain experienced and high-potential employees.
The Infertility Journey
Categorized as a disease by WHO, infertility is the inability of a sexually active, non-contraceptive couple to achieve pregnancy in one year. Treatments can involve a combination of heavy hormonal therapies, daily injections at home, frequent and unpredictable early morning visits to the clinic for bloodwork and ultrasounds, or surgery. While some couples achieve a healthy pregnancy within a few months, for many, the process lasts for years. Male-related factors contribute to about 35% of cases, but in the large majority of cases, it’s necessary for the woman to undergo treatment. This article focuses on women’s experience while recognizing that men share some of these challenges and may benefit from our suggestions as well.
Women in their 40s are now the only age group with a rising pregnancy rate. With growing competition in the job market, the early years of career-building can involve longer work hours, more time spent traveling for work, and getting more education. For women, this time often overlaps with the prime years of childbearing. Some women feel they face an either-or choice: Build a career or have children. For a growing number of women, delaying motherhood until their careers are well established feels like the right decision. While this delayed family planning works for many, the inconvenient truth is that women’s fertility sharply declines after the age of 35. For those women who want children, their likelihood of needing fertility treatments increases with age, yet the success rate decreases, often resulting in lengthy treatments.
As treatment lengthens, the combination of physical side effects and the stress of failed treatments month after month can be detrimental to a woman’s emotional health. The financial cost of the procedures further disrupts a family: Fertility IQ puts the average cost of successful IVF treatment at about $50,000. To complicate the situation even more, these challenges can also harm a woman’s relationship with her partner. Research shows that couples who go through unsuccessful fertility treatments are three times more likely to divorce or end cohabitation. It’s not surprising that approximately half of women experiencing infertility rated it as the most stressful experience in their life, and 61% rated it as more stressful than divorce.
Infertility and Work: A Silent Experience
Research shows that experiencing infertility can have a tremendous impact on the daily life and professional roles of women. Going through it in silence precludes women from receiving support from their employers throughout the process. Through our own experiences and in talking to women who have undergone fertility treatments, we’ve found the following work-related side effects especially problematic:
Making appointments work. Treatment commitments can become so frequent that it can feel impossible to manage trips to the clinic and continue working. Appointments are time consuming and unpredictable and often require recovery time, adding stress to an already overwhelming process. If life and work are not modified to create space for this new stressor, the setting can quickly lead to burnout and potentially depression, pushing a woman into a vicious cycle of stress, reduced performance, and reduced fertility prospects.
Loss of support. In some cases, the physical and emotional challenges of treatment inhibit a woman from performing at her best. Taking time off, missing out on important meetings, and struggling to stay on top of work can be interpreted by employers or colleagues as slacking or lack of motivation. This can result in poor performance evaluations and being passed over for promotions or new opportunities.
Holding back. Many women make changes to their lifestyles to avoid stress, which is linked to lower chances of pregnancy. Some women may leave a stressful role for one that’s more manageable alongside demanding treatments. In anticipation of a soon-to-come pregnancy, some women put their careers on hold and don’t apply for promotions, better positions, or new projects.
Leaders and HR managers who are unaware of an employee’s challenges are in the dark when assessing her ambitions or evaluating her performance, leaving the employee at a disadvantage and stifling efforts focused on diversity and retention. Unless employees know they will be supported, they will be reluctant to disclose their personal situations. If you’re in a position to create or influence company policies, consider the following actions to ensure you’re supporting your employees as they go through fertility treatments:
Give voice to the silence. Recognize that infertility is a normal aspect of our lives and discuss it openly; don’t hold back from using terms such as “infertility,” “IVF,” or “miscarriage.” Normalizing the conversation around fertility can be an important step in moving out of the silence and creating an environment where women feel supported to share their treatment and career plans with their employer.
Create infertility-informed policies. Despite infertility being designated a chronic illness, most employer benefit plans do not cover its treatment. This means employees may not be able to use sick leave or any of the other support mechanisms available to people experiencing other chronic illnesses. Creating a fertility policy that covers benefits such as time off pre-conception, reduced hours and duties, counseling, and financial support can help employees navigate the challenges around their treatment. This can also send a strong signal that you’re a family-friendly employer, which can help attract and retain talent.
Provide guidance to managers. Educate managers about the impact of fertility treatments on work and provide guidance on potential solutions. Managers need to keep in mind that managing treatment appointments around work can be difficult, and leniency and offering employees a routine that allows them to be out of the office as they go through treatment can go a long way toward ensuring they feel supported and can better manage their work. It’s also important to understand that fertility treatments can necessitate sick leave.
Offer flexibility in career planning. Infertility is an idiosyncratic experience. While some women may choose to move to less-stressful positions during treatment, others may prefer to seek challenging opportunities in anticipation of a slower pace after pregnancy or as a positive emotional offset to the struggles of infertility. The former benefits from programs that will help her get back on track when she’s ready, whereas the latter appreciates the support to freely pursue her ambitions despite her unpredictable life setting. Flexibility in career planning allows both to prosper.
Originally posted on Harvard Business Review