People manager guide: Fertility challenges, investigations or treatment

Employees may also be reluctant to tell their manager or colleagues about their experiences for fear of being overlooked for career opportunities or being seen as not committed at work.

Fertility challenges should be seen as an important workplace wellbeing issue because they can have a considerable effect on someone’s physical and mental health. 

Offering compassionate support as a line manager can have a significant impact, helping someone to balance work demands with their personal experience. If employees feel supported and can access helpful adjustments at work, resources and/or flexibility, they are more likely to feel able to carry on working to the best of their ability. Conversely, having to negotiate and appeal for time off and pay can add to someone’s emotional distress. An unsupportive workplace can result in them needing to take a longer period off work or even leaving the organisation.

According to the NHS, infertility is when a couple cannot get pregnant (conceive) despite having regular unprotected sex. There are two types of infertility:

• primary infertility – where someone who’s never conceived a child in the past has difficulty conceiving
• secondary infertility – where someone has had one or more pregnancy in the past, but is having difficulty conceiving again.

Infertility affects around one in six couples most of whom are in employment. It affects men as well as women. There are many different treatments for fertility problems, including but not limited to:

• medical treatment for lack of regular ovulation
• surgical procedures such as treatment for endometriosis, repair of the fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity
• assisted conception such as IUI or IVF.

Treatments may involve frequent medical appointments. Length of treatment, number of treatments and side effects all vary considerably, which means fertility journeys are highly individual, unpredictable and complex.

Taking an inclusive approach also means recognising that many people do not choose to be childless and this can be very challenging for them to manage socially and at work. They can feel excluded at work, or may experience grief and loss, which can be exacerbated by certain events that are family-focused or by a lack of understanding and empathy.

Men or women can be childless and not actively trying to conceive because of their personal situation or circumstance, for example because they have not met a partner at the right time in life. The reasons for childlessness can be complex and organisations need to be sensitive to everyone’s situation.

This means not asking direct questions about their family status or making assumptions about whether or not they have or want a family. Such questions may seem like a friendly or casual enquiry but could feel very personal and/or upsetting for someone experiencing involuntary childlessness.

Make sure you understand your organisation’s framework for managing and supporting employees who experience fertility challenges, investigations or treatment. This includes:

• health and people management policies
• options for formal and informal flexible working
• procedures for making workplace adjustments and managing sickness absence/return to work 
• specialist support such as occupational health, an employee assistance programme and counselling services, if available. 

Relevant manager behaviour

This relates closely to the behaviour area Providing knowledge, clarity and guidance. Look at Exercise 4 for advice on how to develop this area.

Everyone’s experience of fertility challenges and/or childlessness will be personal, and so appreciating individual needs and responding in a sensitive and flexible way is key. Unfortunately, one employee may experience multiple cycles of unsuccessful treatment, and the support someone needs may change over time. The key point is to not assume what support people will want and be guided by the individual. 

Organisations should offer support to anyone experiencing fertility challenges, investigations or treatment. This includes men and women, same-sex couples, people pursuing parenthood alone, people choosing to delay parenthood (ie through egg freezing) and people with secondary infertility (ie has a child or children but is having difficulties conceiving again). It’s also important to recognise that some people, for many different reasons, could use surrogacy to start or grow a family and they too could experience infertility.

Relevant manager behaviour

It’s important when supporting someone experiencing fertility challenges, investigations or treatment to take a flexible, individualised and compassionate approach. This relates closely to the behavioural area Building and sustaining relationships. Exercise 5 in the manager support materials offers advice on how to develop these behaviours.

As soon as you are aware that someone is experiencing challenges and/or treatment, it’s important you acknowledge it. They may or may not want to talk about the situation in detail, but acknowledging it is very important. Asking open questions such as “How are you doing?” will help them feel they can talk to you about their situation if they need to or want to.

Developing your capacity to build and sustain relationships, particularly around showing concern for people and interacting with them in a friendly way, can help with this. 

Relevant manager behaviour

This relates closely to the behaviour area Building and sustaining relationships. Look at Exercise 5 for advice on how to develop this area.

It can be hard to know what to say to someone who has shared their experience. Some people worry about saying the wrong thing and so say nothing at all, which could feel very isolating for someone who is having a difficult time. It’s important to be guided by the individual, and some people may choose not to discuss it. This should be respected, but colleagues can still ask how someone is, showing they care but giving the individual the choice and space in how to respond.

Key advice from Fertility Network UK, drawn from people experiencing fertility problems, includes:

• Asking questions: in general, people prefer it if colleagues show an interest in their problems and ask how their investigations/treatment are going and how they are feeling. It is better to ask (or ask if it is okay to ask) than to say nothing because you are afraid of upsetting them, as this can give the impression that you don’t care.
• Acceptance and advice: it’s very important to accept that the person really does have a fertility problem if they tell you so. It’s best to leave advice to the medics.
• Reassurance and encouragement: there is little reassurance you can give to a couple about whether they will eventually have a baby. Going for fertility treatment is not like going for a job interview; a positive attitude does not improve the chance of success, so advocating ‘positive thinking’ is not necessarily helpful. 
• Empathy and support: infertility can be experienced like a bereavement. The grieving process is long and drawn out because they may find it hard to start to come to terms with their loss until they are satisfied they have tried all the options they are prepared to undergo, or can afford.

When appropriate, it’s important to have a sensitive and supportive discussion about the employee’s needs. You might find the conversation checklist below helpful. 

Conversation checklist 

• Avoid interruptions: switch off phones, ensure colleagues can’t interrupt.
• Be caring and show concern for the employee’s wellbeing. 
• Ask simple, open questions, such as, “How are you doing at the moment?” 
• Ask, “What support do you think might help?” 
• Avoid judgemental or patronising responses. 
• Speak calmly.
• Maintain good eye contact.
• Listen actively and carefully. 
• Encourage the employee to talk. 
• Be prepared for some silences and be patient. 
• Focus on the person, not the problem.
• Avoid making assumptions or being prescriptive – the individual is the best person to know what support, if any, may help them. 
• Thank the employee for sharing their experiences.
• Follow up in writing, especially agreed actions or support.

This checklist has been adapted from the CIPD and Mind’s people manager’s guide to mental health.

Assure the individual that your conversation is confidential, but it’s also important to discuss what information, if any, they would like communicated to work colleagues about their situation.

Relevant manager behaviour

This relates closely to the behaviour area Being open, fair and consistent. Look at Exercise 1 for advice on how to develop this area.

You will need to have awareness and sensitivity around certain events that could be upsetting, such as Mother’s Day or Father’s Day, pregnancy announcements and baby showers. You should also aim to build this awareness and understanding in your team.

This compassion and understanding should also apply to anyone who is affected by childlessness, and it’s important not to make assumptions about anyone with or without a family. 

Make sure you actively support team members who may be living through very contrasting personal situations. This doesn’t mean that an employee who is expecting a child can’t share their experience and anticipation, but you and other colleagues need to show compassion and sensitivity if you know another team member has not been so fortunate. 

For example, you could anticipate certain events that could be upsetting for someone experiencing fertility challenges and/or childlessness. Have a conversation about how best to support them. You could develop an agreement around pre-warning, allowing the individual to excuse themselves or be busy elsewhere at points that could be particularly upsetting.

If an employee needs to take time off work for a medical appointment related to fertility, this should be treated in the same way as time off for any other medical appointment. As a first step it’s important to check your organisation’s policy to see if it includes paid time off for fertility investigations or treatment, and what other provision is available for people.

Experiencing fertility issues can require employees to take multiple absences from work, particularly given the medical aspects of some treatment and/or investigations. Sometimes appointments can be fitted in around work, particularly where flexible working arrangements are in place, but this will not always be the case. 

Managing appointments alongside paid work can add to an employee’s stress, particularly as appointments may need to be arranged with little notice and they often don’t know how long investigations and/or treatment will take. Some absences related to fertility investigations or treatment can be hard to plan as an individual could be called to a clinic at very short notice. Others may travel abroad for treatment and could need a certain amount of time off work.

Experiencing difficulties conceiving can also be extremely stressful, as people can be going through what is often an uncertain journey of investigations and treatment, which can take up considerable time and energy. Most people find it very challenging to balance these demands alongside paid employment. 

Undergoing an unsuccessful course of fertility treatment, or ongoing fertility challenges, or having to end a fertility journey without a successful pregnancy, can be very challenging for someone’s mental and emotional wellbeing. To many people it will be experienced as a bereavement. Being offered time away from work to recover and to deal with the wellbeing impacts of their situation can help individuals to cope and remain in work.

One employee’s experience of fertility challenges, investigations or treatment can be entirely different from another’s. Therefore, you should be responsive to people’s unique needs and offer leave and time off according to your organisation’s policy. 

If someone is absent due to fertility challenges, investigations or treatment, have a sensitive conversation with them about how best to keep in touch during their absence. This should be approached with empathy and without the employee feeling any pressure to return to work before they are ready.

Employees are more likely to return to work safely and productively following a period of sickness absence if they are well supported during their absence and on their return. How you manage these situations will make a difference to whether the individual makes an effective return to work. 

You should plan and carry out a return-to-work interview to help ease the employee back into work when ready. An effective return-to-work interview can build trust with the employee. This should be planned before someone returns so that they know what to expect and have the opportunity to think about any issues they would like to raise, such as potential adjustments. 

It’s best to advise someone in advance what to expect at a return-to-work interview. Make it clear that this is a supportive process to help them make a successful and lasting return to work and address any ongoing health and wellbeing needs. It’s important to remember that an employee returning after an absence, particularly if treatment was unsuccessful, could feel overwhelmed and self-conscious. Many people could benefit by having a phased return or working from home as well as possible adjustments to their workload and/or duties.

The CIPD guide on managing a return to work after long-term absence sets out these guiding principles to follow when navigating the key steps to managing an effective return to work:

1. maintaining communication while absent
2. preparing for a return to work
3. supporting the employee and manager during the immediate return
4. supporting the employee and manager on an ongoing basis on return.

Relevant manager behaviour

The behavioural areas that are particularly important in this context are: 

Building and sustaining relationships. Exercise 5 offers advice on how to develop these behaviours. 

Being open, fair and consistent. Exercise 1 and Exercise 2 offer advice on how to develop these behaviours. 

Providing knowledge, clarity and guidance. Exercise 4 offers advice on how to develop these behaviours. 

Some employees may require adjustments to their job role, work environment or work schedule if they are experiencing fertility challenges, investigations or treatment. 

It’s important to talk to the employee as they will be in the best position to know what adjustments or support can help. These will depend on many factors, including the nature of the employee’s job and their unique needs. Every employee’s experience will be different and so there is no uniform set of adjustments that an organisation can put in place. As someone’s fertility journey can be unpredictable and change over time, different work adjustments and/or support may be needed at different times.

Flexible support and/or adjustments for employees can include a combination of approaches, for example:

• ensuring they are not working excessively long hours 
• allowing them to switch to different tasks on bad days
• permission to excuse themselves from triggering situations
• temporary/informal changes to their work schedule (for example, short breaks, leave for appointments)
• formal flexible working arrangement (for example, working from home, reduced hours or extended leave)
• changes to an employee’s role or responsibilities (for example, a reduced workload or temporary change in duties)
• changes to the work environment (for example, relocation of desk to a quiet space). 

Relevant manager behaviour

Providing knowledge, clarity and guidance. Exercise 4 offers advice on how to develop these behaviours.

Return to work is often seen as a one-off event, but many people need ongoing support:

• Have regular conversations: have regular conversations with employees about how they are doing and what support they might need. As part of those conversations, discuss how any support or adjustments are helping the employee to manage their situation. 
• Take health and wellbeing into account when considering performance: approach performance conversations supportively and positively. Take any health and/or wellbeing-related issues fully into account where there is underperformance. Identify any extra support the person may benefit from, such as more training or supervision or workplace adjustments. 
• Consider the impact on other members of the team: consider the impact on other members of the team that sick leave/a phased return or changes in duties might have. Make sure that other team members are being supported if they have additional work to do.
• Listening, treating people with respect and bringing kindness and consistency will help you provide this support, as will your capacity to build and sustain relationships, while skill at handling conflict and people management issues may also be needed. 

Relevant manager behaviour

This relates closely to the behaviour area Being open, fair and consistent. Look at Exercise 1 for advice on how to develop this area.

It’s important to understand what your role is in supporting people experiencing fertility challenges, investigations or treatment. This also means maintaining clear boundaries. For example, you are there to support people and to put in place any workplace adjustments, but you are not a medical expert or counsellor. 

Supporting someone who is experiencing a difficult situation like infertility can be challenging for you as a manager. It is worth considering what specific support is available within your organisation that you can draw upon if needed, like expert advice from HR on people management policies or from occupational health if available. You might also want to explore how to develop your capability to remain calm under pressure and your capacity for self-compassion and self-care. You should always talk to the employee first before discussing their situation with others, to make sure they are comfortable with you sharing information about their situation.

It could be that you feel unable to support a team member who is experiencing fertility challenges, investigations or treatment due to an experience of your own. If this is the case, talk to HR or your own manager about the situation. Your wellbeing is just as important as the employee’s, and there should be other colleagues such as HR who will be able to step in and provide support. 

Make sure you signpost team members to helpful services and resources, if your organisation offers them, such as occupational health and employee assistance programmes, or point to external sources of support.