What Do Employers Need to Know About IVF?

In the battle to attract and retain talent, organizations are looking for new and innovative ways to support family building for the long-term health and well-being of their employees. Fertility treatments help aspiring parents on any path to parenthood access the care they need to start and grow their families. One of these treatments is in vitro fertilization (IVF), a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

More employers are offering fertility-specific benefits

While most company policies and initiatives support the visible parts of the family-planning journey, such as pregnancy, childbirth, and issues like parental leave and work-life balance, fertility challenges tend to be invisible. Despite the outsized impact infertility can have on productivity, financial health, and happiness, only 31% of employers with 500 or more employees offer some kind of fertility benefit, with IVF as the most common treatment covered. In order to attract, retain, and support talent, it's important for leaders to understand the potential impacts and ramifications of fertility treatments and take steps to enable employees to thrive at work and at home.

Infertility, Work, and IVF

Categorized as a disease by the World Health Organization, infertility is the inability of a sexually active, non-contraceptive person or couple to achieve pregnancy in one year. A growing number of women are experiencing infertility, with an estimated 12% of women in childbearing years facing difficulty getting pregnant or carrying a baby to term. It's important for employers to be aware of the connection between infertility, IVF, and work, as your employees may be facing these challenges.

The Financial and Emotional Impact on Your Employees

Lengthy, arduous fertility treatments can have intense financial and emotional impacts on your employees. Research shows that the psychological toll of infertility experienced by women is similar to coping with a physical illness, such as cancer, chronic pain, or HIV. Likewise, men are likely to experience depression, anxiety, and sexual dysfunction when challenged with infertility within the family. 

Infertility struggles can also damage a person’s relationship with their partner. Research illustrates that couples who endure unsuccessful fertility treatments are three times more likely to end cohabitation or divorce. Unsurprisingly, half of the women experiencing infertility ranked it as the most stressful experience in their life, and 60% ranked it as more stressful than divorce. 

Fertility treatments can be prohibitively expensive, too, if not completely inaccessible to most people. Most patients pay out of pocket for IVF because many insurance companies don’t fully cover the cost of treatment, if at all. Even with coverage, IVF treatments can cost on average upwards of $60,000 for successful outcomes.

IVF and the LGBTQIA+ family-building experience

More families than ever are starting families in non-traditional ways, including through fertility treatments like IVF. These modern paths to parenthood enable LGBTQIA+ individuals and single parents by choice to start and grow a family. . 

While IVF is commonly used to assist in fertility and conception for women struggling with infertility, same-sex couples often turn to IVF to contribute genetic material to the baby. However, LGBTQIA+ people are often excluded from such treatments and have to overcome more barriers to start a family. For insurance to cover IVF, cisgender and heterosexual couples are often required to prove that they’ve been trying to get pregnant through sexual intercourse for a year minimum with no resulting pregnancy. Due to this narrow definition of infertility, most LGBTQ+ couples, single-intending parents, and anyone pursuing parenthood outside of a heterosexual, cisgender partnership are excluded. 

IVF is inherently out of reach for individuals who can’t afford to receive an infertility diagnosis without employer benefits. This, plus insurance restrictions, financial burdens, and general lack of support, creates significant obstacles for the 63% of LGBTQ+ millennials trying to expand their families either by becoming parents or having more children.

The IVF Process and Its Impact at Work

There are five steps in the IVF process:

1. Superovulation to Boost Egg Production

Superovulation is a stimulation process to boost egg production. The process begins with giving the patient drugs containing Follicle Stimulation Hormone (FSH), administered by needle, which induces egg growth in the ovaries. The more eggs they produce, the higher chance they'll experience successful fertilization later in the treatment. 

The patient will also receive blood tests and transvaginal ultrasounds regularly to monitor their hormone levels and check on their ovaries. Sometimes they’ll experience bruising, tenderness, or pain at their injection sites. Hormonal medication might also cause emotional changes like mood swings, restlessness, irritability, or generally feeling down, as well as nausea, bloating, fatigue, and possible hot flashes.

2. Egg Retrieval

A day or two before the patient’s eggs are scheduled to be retrieved, they'll receive a hormone injection that will assist the eggs in maturing more quickly. Then, they'll undergo a minor outpatient surgical procedure called follicular aspiration to extract the eggs.

They’ll likely experience some mild to moderate abdominal cramping and/or pelvic pain, but the NIH says that this pain is usually mild enough to be treated with over-the-counter pain medicine and disappears within a day or two after the procedure.

3. Sperm Collection from Partner or Donor

During the egg removal process, the patient's partner will provide a sperm sample or a sample from donor sperm. The sperm are then sorted through a high-speed wash and spin cycle to find the healthiest ones.

4. Unite sperm and eggs

Then, the best sperm is combined with the best eggs in a process known as insemination. It typically takes a few hours for a sperm to fertilize an egg, and the doctor may choose to inject the sperm directly into the egg instead via a process called intracytoplasmic sperm injection (ICSI).

5. Embryo Transfer

Once a patient's eggs are collected, they will receive another medication to prep the lining of their uterus to receive the embryos that will be transferred back into her. A few days after fertilization, the doctor will place the embryos in the patient’s uterus using a catheter. Multiple embryos are transferred back into the patient during this step in the hopes that at least one will implant itself in the lining of the uterus and develop. 

Pelvic infections are rare but are a risk during the embryo transfer steps of IVF. Some doctors prescribe antibiotics before and after the procedures to prevent infection. The final step after the IVF process determines whether the treatment worked, and the patient takes a pregnancy test. 

While many people find success with IVF, not every procedure ends with pregnancy. An unsuccessful treatment can be terribly disappointing, and as the American Society for Reproductive Medicine (ARM) says, while IVF does not increase the risk of miscarriage, pregnancy loss after enduring an intense process can be even more emotionally devastating.

Impacts on work

During the IVF process, patients need a significant amount of time off from work: about eight to ten partial days over the course of a month, with a full day off for egg retrieval. During this time, patients' bodies can react in different ways to the treatments, and milestones can be met at different times throughout the period. 

In addition to missing time at work, it’s likely that patients will be less productive during the IVF process. The emotional and physical implications of such a time and resource intensive process can reduce productivity, especially when women experience physical or emotional pain as a result.

IVF and Rights at Work

Discrimination

Sadly, people undergoing through fertility treatments often face discrimination in the workplace. Fertility treatment doesn't offer the same protections as pregnancy when it comes to employment law, despite considerable numbers of people undergoing IVF. Should an employer dismiss a woman's unemployment due to absence or sickness caused by IVF, it's difficult to back up a claim. 

Moreover, many women hesitate to share their struggles regarding infertility due to their concern about its impact on their careers. According to a recent survey, 50% of women did not disclose their fertility treatment to their employers because they feared that the employer wouldn't take them seriously, and over 40% due to fear about its negative impact on their career prospects. 

HR managers and leaders who are unaware of an employee's fertility challenges may not have the whole story when evaluating their performance in the workplace, leaving employees undergoing IVF at a disadvantage and repressing efforts toward retention and diversity. Unless employees know they have the support of their organization, they will be reluctant to disclose their situations. Creating clear, written company policies that make all employees aware of the assistance available to them can help build a safe environment and invite open discourse. Managers should be training on how to support employees when implementing the policies, so all employees going through IVF are treated fairly, confidentially, and consistently.

Taking Time Off

Women typically have to take time off from work to attend doctor's appointments and go through fertility treatments, which can raise questions regarding their commitment and loyalty to their company. Legally, employers can require that such appointments be taken as holiday requests or unpaid days off unless the employee is pregnant and has to partake in antenatal classes. While the hope would be that employers allow some flexibility, the standard approach is to suggest that employees take appointments outside of work hours. 

Leaders looking to support women on their fertility journeys should consider creating infertility-informed policies that make space for employees undergoing fertility treatments. Since fertility treatments are not covered by most employer benefit plans, employees may not be able to use sick leave or any other kind of support usually available to people experiencing other illnesses. Establishing a fertility policy that covers benefits such as reduced hours and duties, financial support, time off before conception, and counseling can assist employees in navigating the challenges around their treatment. It can also send a strong signal that your organization is family-friendly.

How to Support Your Employees Going Through IVF and Working

Women experiencing infertility shouldn't have to worry about pursuing their ambitions amid unpredictable and stressful life settings. Companies that work to assist employees during this difficult period of family planning will attract and retain valuable talent while bolstering inclusion efforts. It's time for leaders to better support the emotional, physical, and financial health of their employees through initiatives like:

• Comprehensive fertility health benefits
• Flexible work arrangements
• Access to mental health resources

As the world's largest virtual clinic for women's and family health, Maven connects members seeking or undergoing fertility treatments with on-demand content, a welcoming community, and specialty care providers to help them successfully navigate fertility treatments. To find out how Maven can help support your efforts towards supporting meaningful outcomes for all paths to parenthood, including IVF, surrogacy, and adoption, request a demo today.