Dr. Jeremy Thompson has dedicated his career to reproductive research. A Professor at the University of Adelaide, he has more than 200 publications. From 1999 to 2004, he served as the director of the IVF lab at Repromed, and in 2019 he co-founded Fertilis, a company that develops micro-medical devices to improve embryo growth environments and IVF success rates.
In the more than 40 years since Louise Brown, the first person conceived via in vitro fertilization (IVF), was born, the public perception of IVF has changed drastically, much to the benefit of the 186 million individuals struggling with infertility globally.
More than 55,000 Americans give birth to a baby conceived via IVF each year; globally, the number of IVF babies born annually (pdf) is about 500,000.
The demand for fertility treatment has increased steadily over the years, and more recently, there’s been a growing trend of employers offering fertility benefits to their employees.
In the battle for talent, companies such as Boston Consulting Group, Spotify, and LinkedIn offer generous fertility packages. In 2020, more than 42% of U.S. employers with more than 20,000 employees covered IVF treatment. However, for companies with more than 500 employees, only 27% covered IVF.
However, IVF is emotionally and physically trying even when it’s successful. Employers can help to create a supportive work environment for employees going through the treatment with a few simple actions.
IVF: understand the impact and provide financial support for employees
Unfortunately, IVF success rates have not kept pace with the uptick in interest. After decades of research and clinical practice, an IVF cycle is still more likely to fail than succeed.
For the approximately 7.4 million Americans who struggle with infertility, that’s a devastating and costly truth. In the U.S., most women under 37 will need at least three cycles of IVF to have a 50% or more chance of a child. A single IVF cycle can cost between $10,000 and $25,000. At those prices, it’s no wonder that more employees are seeking fertility benefits as part of compensation packages. Unfortunately, successful fertility treatment is impossible for many families without financial assistance or privilege.
Any financial support is helpful, but companies should commit to providing the most significant coverage they can afford for it to be truly effective. IVF success rates increase with each cycle. By providing coverage for at least three cycles, companies can increase the likelihood of employees successfully conceiving while avoiding starting them on a course of treatment that they can’t afford to complete.
Beyond providing financial assistance, companies and HR leaders must educate themselves about IVF. Without understanding the timelines, complexity, and uncertainty of the IVF procedure, employers will find it challenging to provide the necessary support to employees undergoing treatment.
Much of the media coverage of IVF features happy success stories or catastrophic mistakes (e.g., parental mixed-ups during embryo implantation). Still, the reality is that most IVF journeys—successful or unsuccessful– will consist of a lengthy period in which the normality of the day-to-day life for patients fluctuates between exciting peaks and disappointing troughs. By building their understanding of the IVF experience, leaders can approach an employee’s fertility journey with empathy and compassion.
Provide time off during the IVF process
The timeline for pre-diagnoses and pre-treatment work varies from patient to patient, but employers should realize that months can pass before a patient begins hormonal therapy. In addition, employers should be aware that employees will have to take time off work to attend several visits with a clinical specialist to determine the cause of infertility.
Once a cause is determined, most women must undergo pre-treatment in which they take one cycle of birth control pills to suppress their own hormone production. Unfortunately, they’re likely to experience the side effects of going on the pill: nausea, headaches, sore breasts, bloating, and mood swings, to name a few.
Following the pre-treatment, patients undergo two weeks of hormonal therapy, which self-administer hormone injections. These injections often cause discomfort– bloating, nausea, fatigue, and sinus pain are all common side effects. In addition, some patients will also experience hot flashes, headaches, brain fog, blurred vision, and irritability.
A lot of anxiety accompanies the hormonal treatment phase because being able to deliver the correct dose of the ovarian stimulating hormone at the correct time each day directly affects the number of eggs released. Flexible work arrangements are necessary because they help ensure that employees undergoing IVF can attend frequent doctor appointments and perform daily hormonal injections without unnecessary stress. Work travel isn’t possible from pre-treatment to egg collection because patients have to go to clinics for monitoring appointments, which include ultrasounds and blood tests.
Suppose an employee feels comfortable confiding in their line manager or a member of the HR team about their fertility journey. In that case, these leaders can help during the pre-treatment phase by not scheduling work travel, anticipating the need for extra capacity, and resourcing their teams accordingly. Employees undergoing IVF are likely to experience intense physical side effects on and off for weeks, and they need to be able to rest without falling behind on work commitments. Because it’s already a stressful time, managers should help shield these employees from additional workplace stressors.
Reduce work stress throughout IVF treatment
As employees go through egg collection and treatment, managers can help employees with work-life balance, relieving them from worrying about career setbacks as they navigate the anxiety associated with this time.
After all the pre-treatment physical and emotional stress, it’s possible that a clinician cannot collect any eggs when retrieval comes. Therefore, employers should allow employees time off should egg retrieval fail.
After successful egg retrieval, a patient must wait between four and seven days to know whether the process has resulted in a viable embryo. Embryologists expect to produce one to two viable embryos from eight eggs. However, implantation of a viable embryo comes with its own risks, and employees must wait two weeks after implantation to know whether it’s resulted in a successful pregnancy.
Waiting to find out whether a cycle has been successful is an anxiety-ridden time. An employee might be distracted–unable to focus 100% on their work– and managers should respond with compassion rather than in a way that induces additional stress.
Provide counseling services for employees throughout IVF
Employees are drawn to fertility benefits because of the promise of a healthy baby, but IVF treatment fails for almost one out of every two people. The emotional cost of unsuccessful cycles or pregnancy losses is unquantifiable.
Above all else, companies should provide counseling services for employees battling infertility. In addition, employees will need support from professionals who can help nurture their mental health and wellbeing.
These supports can’t be temporary. The IVF process can last for months or years. After a failed cycle, most specialists encourage patients to wait a few months before the next attempt, which means that an employee’s infertility struggle– and the anguish they encounter along with it– could be something they bring with them to work for an extended period of time.
It’s also essential that grief counselors are available to help in the case of unexpected pregnancy loss. While all pregnancy loss is heartbreaking, for individuals undergoing IVF, miscarriages accompany different kinds of grief. They carry the weight of all that the patient went through– and will go through again– in an attempt to conceive. Most employees find themselves physically capable of returning to work after such a loss, but that doesn’t mean they aren’t struggling internally.
Most of all, counseling services need to be available for the so-called “IVF veterans”—the approximately 40% of people who have been through three or more cycles of IVF and walked away without a baby in their arms. Professional counselors can help them discuss their options, get in touch with their grief, and build a new vision for their lives.
As fertility benefits move from a ‘nice-to-have’ perk to a standard part of compensation, there’s room for caution. The benefits positively impact many people’s lives; however, until technological progress in the lab increases IVF success rates, many people will also discover that fertility benefits can’t compensate for broken dreams. The companies offering these benefits must be prepared to help their employees through successful and unsuccessful fertility journeys.