Over 10 million IVF babies have been born globally since the first human baby was created using in vitro fertilization (IVF) in the UK in 1978. Even more advanced assisted reproductive technologies (ART) currently include intracytoplasmic sperm injection (ICSI) and egg freezing.
But the technology has also introduced difficulties in addition to these increased fertility prospects. Publicly financed fertility treatments are not always available, and their success rates are generally low. This implies that a large number of people worldwide are required to pay privately, if they can, for numerous cycles of treatment. This can equate to tens of thousands of pounds.
For some, it might also mean travel overseas. Inequalities in access and care in the UK have been linked to factors such as patient sexual orientation, ethnicity, age and weight.
Infertility is a disease of the reproductive system affecting one in six people, or around 17.5% of the global adult population, according to the World Health Organization (WHO).
Infertility can be impacted by medical conditions, sexual orientation, and the absence of a spouse. However, despite its high frequency among people of reproductive age and the significant psychological and social costs it can impose, infertility has traditionally been taboo in both public discourse and the workplace.
Up until recently, maternity benefits were the main reproductive journeys that employers paid attention to. This has been mandated by employment legislation in many countries for some time.
But as social attitudes have changed, technology has advanced, and corporate demands have grown, more employers in the industrialized world are paying attention to fertility treatment. Business reasoning frequently underlies this: assisting employees through IVF and similar procedures will improve hiring, performance, retention, and engagement.
Supporting different fertility journeys
Indeed, employer interest in fertility treatment appears to have originated in Silicon Valley in the US. Apple and Facebook introduced fertility benefits (paid IVF and egg freezing) in 2014 as a weapon in the “war for talent.” This was controversial, however, with companies accused of essentially trying to bribe women into delayed childbearing.
In the UK, the focus is generally on well-being. Workplace benefits often center on fertility policies and time off, flexibility and workplace adjustments. But only 3% of employers said they offer such provisions to a significant extent in a 2022 survey. This places menstruation and fertility at the bottom of the list of well-being aids targeted at particular employee groups.
Arguably, the emergence of employer interest in assisted fertility technology has furthered “reproductive stratification.” Research on this issue defines this as when “some categories of people are empowered to nurture and reproduce, while others are disempowered.”
The small number of businesses who do provide fertility-related policies and support typically target permanent, highly valued employees in northern hemisphere nations like the US, UK, and Japan. And so, large proportions of the world’s workforce are missing out.
Other resources that aid with reproductive trips are also lost on migrants and those in unstable employment. This can include having well-trained and supportive line managers as well as secure employment, protection from retaliation, livable salaries, access to sick time, and maternity and paternity leave.
When policies are in place, they are not always inclusive of all employees and all fertility journeys. Our research shows policies often neglect partners and non-normative families (same-sex couples and those pursuing motherhood alone). They often focus on a set number of days off for treatment cycle(s). This may not be sufficient and also fails to consider the needs of staff where treatment is unsuccessful.
And even when employees can access fertility treatments via progressive employment provisions, they often end up being penalized via discrimination or negative career consequences. We found this during a study in which participants reported having to go part-time, switch career focus, leave jobs, or were just generally disadvantaged at work after embarking on a fertility journey.
Campaign groups such as Fertility Matters at Work and Pregnant then Screwed have reported similar findings in international studies and surveys. Since women are most likely to experience these negative career consequences, this means increased take-up of fertility treatment could further existing gendered inequalities in the workplace.
A more equitable future
To fully optimize the hope created by ARTs, governments around the world should expand publicly funded provisions as much as possible (bearing in mind other health care commitments) and ensure equitable access and care. Employment laws should also provide adequate time off and safeguard against discrimination based on access to ARTs.
There is some hope. A private members’ bill to permit people to take time off work for appointments and treatment is now being considered by the UK parliament, but sadly, little progress has been made thus far.
A few other countries have already taken action, however. Malta legislates for 100 hours’ paid IVF leave (per cycle, up to three cycles) split between the “receiving person” and their partner. Korea provides three days’ leave per year (one paid) and protection from discrimination. Japan has also introduced provisions for public workers.
Other recent UK developments include workplace guides from professional body The Chartered Institute of Personnel and Development (CIPD) and government funding for charities to develop resources aimed at small and medium-sized enterprises (SMEs). These are welcome.
However, companies shouldn’t only consider fertility benefits in terms of a cost-benefit analysis while waiting for the government to step up and offer universal coverage. Employers must assist their employees’ fertility journeys in a sensitive and inclusive manner.
