Managing Workers Undergoing Fertility Treatments or Surrogacy

​When Amy Klein started fertility treatments, the clinic was next to the Manhattan office where she worked as a magazine editor. She didn't tell her manager because, initially, she could go to her appointments before work or during lunch.

"Everyone thinks, 'It will just be a few appointments, [and then] I'll just tell them I'm pregnant,' " said Klein, author of The Trying Game: Get Through Fertility Treatment and Get Pregnant without Losing Your Mind (Ballantine Books, 2020). In reality, it took Klein nearly four years to become pregnant, and, during that time, she estimates she took about 10 hours of leave a month, plus time off to recover from miscarriages.

"What starts out as missing work for one appointment morphs into a whole lot of hours of getting to and from the clinic, waiting at the clinic, talking on the phone to insurance, desperately searching for meds when the pharmacy is late or closed … having to take mornings off for [egg] retrievals and afternoons off for transfers," she said.

Fertility treatments involve an emotional rollercoaster of uncertainty as well as a huge investment of time and financial resources, Klein said. Each round of in vitro fertilization (IVF) can cost as much as $15,000 to $20,000, according to experts, and surrogacy can cost as much as $135,000.

Fertility treatments are described as one of the most stressful experiences a person can undergo, said Claire Tomkins, Ph.D., CEO of Future Family, a company that offers financing and coaching for IVF and egg freezing in San Francisco. "Managers should treat fertility much like any other situation of hardship or trauma," she said. "This is right up there with having a divorce in your life or losing a parent or having a family member get sick."

Infertility affects 1 in 8 people, so there's a good chance there are employees at your company undergoing treatment, said Betsy Campbell, chief engagement officer at The National Infertility Association in McLean, Va. When you add same-sex couples and people with diseases like cancer that might require fertility interventions, the number can be even larger, she noted.

Yet, many people are reluctant to discuss their treatment. "It can be unnerving to talk about something so personal that involves sex, getting pregnant and needing to take maternity leave," Campbell said.

Infertility Doesn't Just Affect Women

Don't assume only women are affected by fertility treatments. While a male employee whose wife is going through treatment may not need as much time off from work as a woman having treatment, he is still dealing with the emotions, stress and expense of the process, including disappointment if the treatment doesn't work and grief if there is a miscarriage. For women younger than 35 undergoing IVF, the success rate of carrying a baby to term is 55 percent.

Same-sex couples going through fertility treatments or using surrogacy to start a family also are dealing with uncertainty. "There is a lot of uncertainty about the timeline and a lot of stress regarding financial issues," said Ron Poole-Dayan, executive directive and founder of Men Having Babies in New York City. Couples using surrogacy have additional challenges because they might need to travel to another state to visit the surrogate or go to appointments with her, Poole-Dayan said. "Sometimes people don't acknowledge this is happening to you since you're not pregnant [or] you're not getting the treatments," he added. "But we still feel all the ups and downs."

How to Support Employees

Two of the most important accommodations managers can offer for anyone going through IVF or surrogacy is to keep the lines of communication open and to be flexible with work arrangements, fertility experts said.

Treatment schedules can be unpredictable. "Offer the types of flexibility you would under any other medical circumstance," Campbell suggested. "Sometimes requests will be made at the last minute because treatments are dependent on [the patient's] hormone levels."

In general, an IVF cycle takes about two weeks. Initially, the patient will have five to seven early-morning visits for monitoring, typically between 7 a.m. and 9 a.m., said Lissa Kline, vice president of provider and member services at Progyny in New York City. During each cycle, the patient will need at least one day off for egg retrieval under anesthesia. There will also be two final, shorter appointments for embryo transfer and a blood test. If the transfer doesn't work, most couples take a month or two off and then try again, Kline said.

Keep in mind that most employees don't want to discuss the process or outcomes. "I never told anyone the exact date of the retrieval or transfer," author Klein said. "The hardest thing is being under the microscope and having to deal with other people's expectations."

If a company offers fertility benefits, HR should educate managers and employees about those benefits and explain that employees are under no obligation to tell their manager that they are having fertility treatments. They need only say they need to take time off for medical reasons, Klein said.

If employees reveal they're undergoing treatment, don't ask how it went or when they'll receive news, Klein suggested. Be careful about offering advice that might be unintentionally hurtful, such as telling an employee she just needs a relaxing vacation to get pregnant or suggesting she adopt instead, Campbell warned.

Be prepared for employees to be more emotional than usual. The hormones women take during treatment can heighten their emotions. Fertility patents are at a slightly higher risk of depression and anxiety during their journey, Progyny's Kline said. If you see an employee struggling, offer to make accommodations by either suggesting remote work or offering to lighten the workload temporarily, she said. If the company has an employee assistance program, make sure workers know how to access it, she added.

Redistributing an employee's work could mean bringing another colleague into the discussion, but don't discuss why the employee needs help or is taking time off. Instead, emphasize that the need is related to a short-term, medical situation, Campbell said. "Tell them, 'We want to accommodate this employee just like we would want to accommodate you and want to respect everyone's privacy,' " she said.

Lisa Rabasca Roepe is a freelance writer based in Arlington, Va.