During a four-year-long journey through infertility treatments, Serena Sohrab, an associate professor at Ontario Tech University, would unwind from the mental, physical, and financial toll that came from the process by writing, stream-of-consciousness style, in a café. “It was only toward the end of the treatment that it hit me that I [was] someone dealing with a clinical illness,” she said.

This was the starting point for an article in Harvard Business Review titled “Employers, It’s Time to Talk About Infertility,” co-authored with business-school professor Nada Basir, which spelled out an uncomfortable truth. While visible conditions such as pregnancy and the first post-partum months have started receiving more and more attention in the workplace, especially in the realm of benefits, employers still have a long way to go when it comes to effectively tackling infertility. It’s an issue still shrouded in silence even though it affects one in six couples, Sohrab said, speaking in a recent From Day One webinar, “Supporting Employees With Family Forming, While Managing Costs,” moderated by journalist Siobhan O'Connor.

“When it comes to normalizing the conversation, it comes down to the managers and the leaders to be open about this,” said Sohrab, now a visiting associate professor of organizational behavior at London Business School. “Particularly for women, they have reservations on making their motherhood intentions known. Women as mothers and pregnant women are receiving intangible penalties because they decided to lead a more balanced life."

As far as supporting families and family planning, employers have shown an increasing commitment to do so, but costs are high and options are overwhelming and often confusing. Both employees and employers need to plan for the long game, said Brian Levine, M.D., the founding partner and practice director of CCRM Fertility New York. “I have two girls and right now we’re looking at schools–we're looking at a 13-year journey. As an employer, I’d look for an employee for longevity: fertility is an experience to be supported, not an experience to be managed.”

Meeting the Needs of Employees

One upside of technological advancement is that employers now often consider fertility as an important part of how you treat employees holistically. “You need to understand the employee base, and start thinking about how you can design flexible and simple things,” said Rosanne Cuje, VP of total rewards at Mastercard. “Once you figure that out, you have to think that it’s not a one-and-done approach.”

Moreover, the concept of family is not only the “traditional,” heteronormative family that companies talked about primarily a few years back. “The way we look at families has changed over time, and fertility tools have become a critical need. It’s important to remember that it’s more than just IVF,” said Kathleen Salings, VP of customer success at Carrot, a fertility benefits provider. “At Carrot, we're looking at our plan design to make sure we are inclusive. It’s really about ensuring the needs are there, and supporting them.” Salings pointed to a finding from FertilityIQ, namely that only one in five companies offering fertility benefits today also includes adoption and foster care.

“We do want to be family friendly–whatever definition of family that is,” said Dani Fischer, senior director of global benefits programs at Hewlett Packard Enterprise, noting that all HPE employees have access to six months of parental leave, globally, whatever their type of family. This required a shift in perspective: the designation “infertility benefit,” was expanded to “fertility” as a whole, since the former definition required a formal medical diagnosis that, say, single prospective parents or same-sex couples would hardly ever meet the criteria for.

This is an issue Mastercard’s Cuje encountered as well, after feedback from the company’s LGBTQ employee-resource group, whose members felt left out from the scope of “infertility benefits.” Switching to a more inclusive designation of “fertility” removed a lot of limitations and barriers to egg freezing, prompted the rollout of a global surrogacy and adoption program, and inspired an increase of parental leave to 16 weeks of full pay. “That is the global minimum; many countries, you know, offer much more than that. The U.S. is pretty far behind,” Cuje said. “But that's the minimum global standard that we provide."

Managing the Mental Health Toll

The positive cultural shift is that people have started to talk openly about the actual toll of family planning. “People have been talking about this in whispers, hiding their bruises, scared of saying, ‘I am hurting,’” said CCRM’s Levine. “We have this culture in America where we tell people it's too early to tell someone to tell you’re pregnant, because most miscarriages happen in the first trimester. We’re just protecting others from having conversations about loss. Thank god there are conversations starting around miscarriages.”

Such conversations, however, need to have some structure to provide the emotional support that is needed. “As an individual is choosing their path, there’s the emotional side you do not necessarily think about,” said Salings, reporting that 89% of respondents to a survey said that fertility and family forming has had a negative mental-health impact, and 59% also shared that the subsequent impact was on their work performance. “We see signs of resource depletion,” said Sohrab. “You have had a stable life, and all of a sudden you have this source of constant worry and challenge. Relationship-wise, couples that go through fertility treatments are three times more likely to end their cohabitation or marriage. It's an immense impact.”

Space for flexibility is paramount, Sohrab said. “For women going through fertility treatment, Covid has been a blessing. Managing appointments was a challenge in a work environment where you have a lot of visibility,” she pointed out, offering advice to HR leaders: “Don't make it look like a favor from a manager to an employee. It’s important that HR managers offer training to managers.” On the flip-side, she stressed, a supportive work environment can be immensely beneficial and a source of fulfilment when dealing with such a grueling experience. “Regarding miscarriages,” said Cuje, “when I had one years ago, I took vacation time, sick time. Now, we have bereavement leave, and miscarriage is part of it.”

Planning for the Future

With fertility becoming an integral part of employee-benefit packages regardless of medical diagnosis, the speakers offered a few words of wisdom when planning how to access them. “Understand that infertility is not a finite thing. This is not a two-week experience. It's not just getting eggs in the bank,” said Levine. “Families need to be supported from pre-conception through postpartum–it's a continuum of health care.” In the next decade, he expects people showing up at the doctor sooner to own the process and understand their fertility potential.

Angelica Frey is a writer and a translator based in Milan and Brooklyn.