The experiences and psychological distress of fertility treatment and employment

The use of fertility treatment is increasing, yet despite the fact that the majority of men and women of child-bearing age are employed, there are no statutory entitlements to absence or flexible working during the long, physically and psychologically demanding process of treatment. Policy focuses on supporting expectant and existing parents, and although some organizations have workplace policy relating to fertility treatment, this is not normative and policies vary greatly.

Research published in the Journal of Psychosomatic Obstetrics & Gynecology by Dr Nicola Payne and Professor Olga van den Akker (Middlesex University) in collaboration with Fertility Network UK (Susan Seenan) reported the results of an online survey of 563 employees in the UK. The survey examined their experiences of combining fertility treatment and work and some key findings are reported below. The article may be accessed at http://eprints.mdx.ac.uk/24066/

Absence from work: The average number of days of absence during a treatment cycle was nine, but 50% of participants took more days than this, with some taking more than a month. More days of absence were associated with reports of greater levels of distress related to treatment. The most frequently reported methods to manage absence from work were the use of annual leave and sick leave. Only 23% reported their workplace had specific policy relating to treatment and those with no policy experienced greater levels of distress related to treatment. Where policies were available they varied greatly. In some cases policies stated that fertility treatment is elective so no absence from work was allowed. In other cases the policies were vague or left decisions to the discretion of the line manager. Some policies allowed a specific number of (paid or unpaid) days of absence (generally between 2 and 10 days) but often restricted the number of treatment cycles that would be supported (generally between 1 and 3).

Disclosure: 74% of participants disclosed to at least some colleagues. Of those who disclosed to colleagues, 35% received a great deal of support, 47% received a bit of support and 18% received no support. 72% disclosed to their employer. Of those who disclosed to their employer, 42% received a great deal of support, 48% received a bit of support and 10% received no support. Those with no support from their employer reported greater levels of distress related to treatment. The most frequently reported reasons for non-disclosure to their employer were that it is a private matter, fear their employer would not understand and fear of career consequences, stigma and gossip. The most frequently reported reasons for disclosure to their employer were needing to ask for leave, wanting to be honest and having a good relationship with their employer. However, 60% reported their employer would benefit from education/support to help them better understand the needs of employees having treatment.

Combining work and treatment

58% of participants reported work affected their treatment (e.g. it was difficult to make clinic appointments), 87% reported treatment affected their work (e.g. it was difficult to concentrate) and 51% were concerned it would affect their career prospects. These concerns increased with more cycles of treatment and those who reported these concerns experienced greater levels of distress related to treatment.

Conclusions

Overall the findings suggest that workplace policy is needed. This may have implications for psychological and physical health and some research evidence suggests that psychological distress may affect fertility treatment outcomes. The provision of workplace policy may also benefit the employer through increased employee commitment and retention. Workplace policy should incorporate flexibility, so that, for example, time can be made up later. Guidance for supervisors/line managers, who may have limited understanding of the needs of someone having treatment should also be incorporated to ensure that policy is effectively translated into practice. Ideally this would be combined with clinical practice changes in flexibility of clinic appointments to allow at least some of these to take place outside of working hours. Additionally, psychological intervention to support those having fertility treatment is needed and should incorporate discussion of work-related difficulties and dilemmas.