“When are you going to start a family?” she asked. It was 1999. I was in my mid-thirties and recently married, so my mother’s question didn’t surprise me. But I wasn’t sure what to say. I decided to come clean: It could take a while if it happens at all, I told her. I didn’t ovulate. I was infertile.
She was having none of it. “Having a baby is the most natural thing in the world!” my mother exclaimed, passing the phone to my father, who wasn’t about to discuss the subject. The call ended abruptly, leaving me distraught. I had shared my secret but found no comfort. Instead, the interaction triggered my deepest fear next to that of never becoming a mother: If I couldn’t conceive, I was to blame.
My menstrual cycle began at a young age but over time became increasingly irregular until ultimately, around age 20, it stopped altogether. Although this scenario is a classic sign of an endocrine disorder called polycystic ovary syndrome (PCOS), as I’d later learn, multiple doctors along the way told me I was too active in sports, not eating enough, or just too anxious or stressed to menstruate. In other words, it was my fault I wasn’t menstruating. Which meant it was my fault I wasn’t ovulating. And because I wasn’t ovulating, I “obviously” couldn’t conceive, according to a women’s health book I consulted in those pre-Internet days.
Those words haunted me for well over a decade, fueling deep-seated fear and shame.
But mine is one of the happier stories. My father eventually called back with the name of a fertility specialist. I was diagnosed with PCOS, which affects one in 10 women of reproductive age, and within three-to-four months, I was pregnant. My fertility benefits through my employer covered the cost of the pills to help me ovulate (Clomid) and a simple and successful intrauterine insemination procedure (IUI) that was necessary to overcome my husband’s fertility challenges. The technology company I worked for offered $15,000 toward treatment; it was among the ~25% of organizations that offered a fertility benefit at the time.
A small window into what fertility treatment can entail
I was extremely fortunate. Unlike so many other infertile women and men, I didn’t have to experience a year’s worth of failed attempts and disappointment before qualifying for fertility treatment. I didn’t have any of the common side effects of Clomid, like vision loss, vomiting, or depression. I didn’t need multiple rounds of an IUI, a procedure that costs about $4000. And because IUI was successful for me, my case didn’t escalate to in vitro fertilization (IVF), a complex, high-risk procedure that takes up to six weeks to complete, involves between 15 and 50 injections, and can cost between $15,000 and $30,000 per round. (In 2021, ~2.3% of all infants born in the U.S. were conceived through the use of IVF.) I also didn’t need to anguish over my state denying access to IVF altogether.
Last but not least, unlike so many aspiring parents needing fertility treatment, I had a supportive employer and flexible work environment that allowed me to navigate my fertility journey with ease. For healthcare professionals, teachers, pharmacy employees and so many other workers, managing the demands of an intensive, time-consuming fertility process can prove extremely challenging. Often the only recourse is to take an unpaid leave of absence under the Family and Medical Leave Act (FMLA), that is if they can prove their case qualifies as a “serious medical condition.”
Each infertility journey is unique, but all take an emotional toll
Every infertility journey is unique, ranging from the fairly simple to the highly complex, the short to the multi-year, the cost effective to the cost prohibitive, and the successful to the unsuccessful. Common to most infertility journeys, though, is a serious emotional and mental toll. In fact, research has shown that women with infertility have the same anxiety and depression levels as women with cancer, heart disease and HIV.
The toll can worsen with every failed attempt to conceive, especially for those lacking a support system. Of course, due to the deeply personal nature of infertility, people often keep their experience hidden, even from friends and family who could potentially offer support.
At work, many women choose not to disclose fertility treatment out of concern they won’t be taken seriously or that their career prospects will be negatively affected. But hiding fertility treatment can also create problems: If unexplained absences mount, for example, colleagues may begin to question a woman’s work ethic or dedication to her job.
Infertility stigma fuels shame and guilt
Stigma also plays a major role in keeping infertility in the shadows by fueling shame, guilt, humiliation, anxiety, and other negative emotions. Despite the fact that infertility is common, affecting 15% of couples and about 1 in 5 married women with no prior births, it still carries a social stigma. “Many societies do not understand that infertility is a disease, so couples are blamed for their condition,” according to Fadi Yahya, MD, obstetrics and gynecology specialist at Mayo Clinic Health System.
To make matters worse, the relationship between infertility and mental health goes both ways. Anxiety has been shown to prolong the time needed to achieve pregnancy, and stress has been shown to decrease the pregnancy rate of women using IVF.
Employers are adding fertility benefits, but employees need more support
Employers are making strides in supporting aspiring parents in their workforce. According to the International Foundation of Employee Benefit Plans, 40% of employers globally now offer fertility benefits, up from 30% in 2020. Thirty percent of employers cover IVF treatments, compared to just 13% in 2016, and 28% cover fertility medications compared to just 8% in 2016.
But employees need more support, Calm research shows. In Calm’s survey of 4,000+ workers around the world, only 35% of respondents said their workplace is supportive of women’s reproductive health. At the same time, about half of respondents who began or completed fertility treatments said their experience affected their mental health and their ability to focus at work. Close to 40% said their experience affected relationships with co-workers. Thirty percent said it negatively affected their sleep.
There’s clearly a need for employers to become stronger allies of employees experiencing the emotional roller coaster of infertility and fertility treatment.
How employers can better support employee mental well-being
Beyond financial assistance, here are a few ideas about how employers can better support employees navigating infertility and fertility treatment.
Build awareness of infertility in your organization
To help break through the stigma and shame, commit to bringing infertility out of the shadows at your organization. If you acknowledge that infertility is both a disease and common, you can begin to make it a priority in your workplace communications. Talk openly about your fertility benefits and policies (even if they have room for improvement) so that employees understand them and know it’s a safe workplace subject. Highlight fertility benefits and policies in your onboarding documents and make sure they’re prominently posted on your internal website. Whenever or wherever you talk about how you’re supporting aspiring or new parents, you should include discussion about how you’re supporting people experiencing infertility/fertility treatment, and miscarriage, as well as those building a family through surrogacy or adoption.
Make it easier for employees to navigate treatment
In the midst of a mentally, physically and emotionally taxing fertility journey, the last thing an employee needs is to fight to qualify for sick days or unpaid leave. Look for ways to build flexibility into your work environment and leave policies so that employees can get to appointments and follow physically demanding fertility treatment protocols. Can you establish a hybrid work arrangement or create a leave policy specifically for fertility patients?
Empower managers to be supportive
Managers can play a significant role in supporting employees undergoing fertility treatment. To better equip them to support employees, educate managers about the prevalence of infertility and how the physical, emotional and mental impact of fertility treatment can conflict with work demands. Help them hold career planning discussions with employees facing fertility challenges, and to develop solutions for them while they go through treatment, whether flexible work arrangements, reduced workloads, or reduced hours.
Finally, train your managers to become more empathetic and to create an open environment in which employees feel safe talking about their emotional and mental health. Calm Workshops are a great place to start.
Offer specialized mental health support
Does your employee assistance program (EAP) offer access to therapists specializing in infertility issues and loss? If not, consider finding an EAP or healthcare advocacy solution that does.
You also can make it easier for employees experiencing fertility challenges to get the mental health support they need. With Calm Health, an employee receives personalized recommendations tailored to their conditions, goals and results of a survey based on the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder screening (GAD-7).
The recommendations include mental health programs written by licensed clinicians, mindfulness content, and/or other options available to them through their employer’s health plan and benefits. For example, an employee could be guided to Infertility: Support for Your Journey, a Calm Health program written by Julie Fraga, PsyD. This 10-episode program teaches people practical tools to unwind anxiety, let go of self-blame, and feel empowered through the ups and downs of their infertility journey.
Help employees access emotional support in the moment
Finally, in addition to improving access to therapy, help employees through challenging moments by offering them access to self-care tools they can use anytime, anywhere. A digital tool such as Calm can help employees better manage their stress and anxiousness, improve their sleep, and recover and reset from the emotional roller coaster. Calm’s expanding catalog of support for women’s health will include support for experiences related to the menstrual cycle and coping with miscarriage.
It’s time employers truly support every path to parenthood, no matter what it looks like. This National Infertility Awareness Week, commit to becoming a better ally for your employees experiencing infertility and undergoing demanding fertility treatment by taking steps to support their mental health and well-being.
For more information on proactively supporting employee mental health and well-being, check out our pricing or connect with a Calm specialist today.
