One thing Tammy Murphy did not have to worry about when she and her partner were undergoing assisted reproduction treatment was the need to keep it a secret from her employer.
A naturally open person, she did not hesitate to tell her manager and colleagues. In return, she got all the flexibility and understanding she needed over the three rounds of in vitro fertilisation (IVF) that it took before her partner, Leanne Doyle, gave birth to their son, Theo, two years ago. On their first attempt, the embryos did not implant; after the second round, she had a miscarriage at 10 weeks.
Murphy’s employer, the recruitment company Flexsource, which is part of the CPL group, has since incorporated fertility treatment supports into its “family building” policies. Five days’ leave per year is available for the person physically undergoing the treatment and two days for the supporting partner.
However, recently published research would suggest that employers making specific provisions are still in the minority in Ireland. This is despite one in six adults, according to the World Health Organisation, experiencing infertility, which is defined as a failure to conceive after at least 12 months of regular, unprotected sexual intercourse.
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About 80 per cent of people who had undergone IVF said their workplace did not have a fertility policy, according to a Sims IVF survey. Almost all respondents (98 per cent) agreed that treatment had an impact on their emotional wellbeing at work, while 83 per cent said it affected their ability to fulfil their work responsibilities.
At support meetings organised by the National Infertility Support and Information Group (NISIG), people often talk about the workplace as being one of the biggest challenges when they are undergoing fertility treatment, says NISIG spokeswoman Caitríona Fitzpatrick.
Fertility treatment involves multiple appointments, sometimes at short notice. In the absence of flexibility or dedicated time off, “people use annual leave or sick leave and it’s really neither of those things”, she says. They can feel quite unwell after some of the appointments, particularly egg retrieval. Emotionally they might not feel connected to the workplace at that time, she points out.
Yet employees often struggle in silence, maybe because they perceive it to be a taboo topic, or they fear that declaring they are trying to start a family may harm their career progression. But keeping it secret not only adds to the stress but also runs the risk that altered behaviour in the workplace may be wrongly interpreted, again to their detriment.
NISIG believes that workplace awareness of fertility issues and a policy to support those having treatment is good for employees and employers alike. It welcomes a new guide for Irish companies produced by Sims IVF, entitled Navigating Fertility Treatment in the Workplace.
It’s just a hugely personal thing to have to say. It’s not a conversation you want to be having until you’re ready, and you’re in a place where you can do it
— NISIG spokeswoman Caitríona Fitzpatrick
Sims IVF is one of the approved providers in the HSE IVF funding scheme that was launched in September 2023. Currently, heterosexual couples who meet the required criteria are entitled to one free cycle of IVF – or ICSI (intracytoplasmic sperm injection, ie sperm is injected directly into an egg), or up to three rounds of IUI (intrauterine insemination) treatment. At the end of June, eligibility for this scheme was extended to couples experiencing “secondary infertility”, ie having difficulty conceiving a second child.
However, there is no statutory entitlement to time off work during what is known to be both a physically and psychologically demanding and complex process. “It is absolutely perverse,” Labour TD Ged Nash told the Dáil in January 2024, “that we have correctly decided funded IVF is a public good, yet access could be restricted to those who can work flexibly, unless a statutory right to leave to access it is introduced.”
He was speaking on a Labour Party Bill that seeks to give workers the right to leave for fertility treatment as well as early pregnancy loss. It is hardly surprising that the impetus for the Bill came from a workplace predominated by women and where flexibility and short-notice leave is particularly challenging – primary schools. Representations from the Irish National Teachers’ Organisation prompted the current Labour leader Ivana Bacik, then a senator, to introduce the Organisation of Working Time (Reproductive Health Related Leave) Bill 2021.
Last month, the Minister for Children, Disability and Equality, Norma Foley, when asked by Laois TD William Aird if she would support the implementation of that Bill, simply referred to ongoing research on relevant issues, adding: “Family leave provisions are kept under review to ensure that they are appropriate to the needs of working parents.”
Since the start of the HSE’s assisted human reproduction treatments (AHR) scheme, there has been an average of 500 referrals per month to the six public regional fertility hubs. Many of these patients can be managed successfully at the hubs via a range of surgical and/or medical interventions and do not require further advanced tertiary treatment such as IVF.
In 2024, the hubs made a total of 1,470 referrals to one of the eight HSE-authorised AHR providers. This year, 911 referrals had been made up to July 7th, according to the HSE.
A review of the first 12 months of the scheme (September 2023 to August 2024), found 262 clinical pregnancies were reported by the HSE’s fertility hubs. A further 79 couples were discharged with a clinical pregnancy from one of the private AHR providers contracted by the HSE.
[ Eight healthy babies born in UK after IVF using DNA from three peopleOpens in new window ]
“It is important to note that relatively few couples had been discharged from a private provider by the end of August 2024, with most of the referred couples still undergoing investigation or treatment,” an HSE spokeswoman adds. “While it is too soon to have meaningful data, the initial results from the service are in line with expectations.”
Although there is undoubtedly much more openness around assisted reproduction, people still experience stigma, says Fitzpatrick. “A lot of it is a self-stigma, in that they’ve kind of judged themselves. All that feeds into an emotional toll,” she says.
People are much more likely to talk about it after they have been successful. “If it’s unsuccessful, or you’re going through it, is where people keep it very quiet because I suppose they don’t want to build up any kind of expectations and they’re still only getting their heads around how to explain what they’re doing.”
They may also worry that the mere mention of fertility treatment might have an employer’s mind jumping forward to the need for maternity leave, as hypothetical as it might be at that stage. At a time when a couple or individual may be investing thousands of euro in private fertility treatment, she says, the fear that they may be passed over for promotion or, say, leadership on a project, “just compounds all this emotional stress”.
“It’s just a hugely personal thing to have to say. It’s not a conversation you want to be having until you’re ready, and you’re in a place where you can do it.”
Availing of a workplace policy would require a privacy trade-off, with disclosure at some level, but a clearly flagged and supportive path when doing this would help. Fitzpatrick says people would not need to indicate exactly where they were in the process.
There are also challenges for employers in addressing these matters, including accommodating a need for time off at short notice, depending on the nature of the work.
“I think knowledge is power,” says Fitzpatrick. “If they get to know this area, then they can work with their employees on it. As with lots of other areas like this, if an employee feels supported they become very loyal to that employer and it’s very hard to put a price on that.”
NISIG sees people who have left their jobs while undergoing treatment because they felt it was too stressful. “Or they would take a sabbatical because they could not deal with that other pressure in the background and what they felt was a total lack of understanding.”
Some really good, proactive employers, she says, ask NISIG to talk their HR department through what assisted reproduction involves and its impact on patients. They use that information to inform their own workplace policies.
NISIG would like to see the provision of designated leave led by legislation but, in the meantime, hopes that “a serious number” of employers will take the need on board “so that it becomes the norm” to have guidance in the workplace.
“Lots of employees will check the maternity policy before they start a family; if they’re going to start medical treatment, they will look at different policies. It should be the same for fertility treatment.”
Then individuals and couples “can make their decisions based around knowing”, Fitzpatrick adds, “as opposed to being halfway through their treatment and suddenly feeling like, ‘I’m going to have to tell somebody,’ and it complicates the whole thing.”
The HR manager at Sims IVF, Niamh Doran, wrote the new guide for employers and fellow HR professionals, drawing on real-life experiences of clients, gathered by last year’s survey, to highlight the challenges and offer possible solutions. Fostering open communication is key, she suggests, as is employees being able to trust their line manager or HR team to be understanding.
“It’s just going to make people feel less like they’re being watched. They won’t feel like it’s going to stunt their career growth, which I think is the number one concern, particularly for women,” Doran says.
The guide includes a fertility policy template for companies to follow when creating their own policies. “If there’s not those examples out there, it’s hard to know where to start. We’re hoping that this is a jumping off point and people can then tailor it to their business needs.”
Ibec declined to comment on issues raised in this article.
Employee voices on fertility treatment and the workplace:
- “I was told it was likely to not work and [will] have to keep trying, so how am I going to manage so it won’t impact on my work?”
- “Empathy drastically dropped after the first two rounds. My boss actually rolled his eyes when I said I was doing the fourth round.”
- “I can see my employer is already trying to recruit for my role in case I go on maternity leave. This makes me uncomfortable as, depending how my treatment goes, I may never go on maternity leave.”
- “I received support from my direct manager; the company overall did not know I was undergoing treatment. There is a need for flexibility around appointments, understanding around absence and general awareness of what the process is.”
- “I haven’t told them as I feel my team lead won’t be happy with it and that might damage the relationship.”
- “My management were helpful, but certified IVF pay would have been amazing as you have to use your own sick pay for days off and treatments.”
- “[I would have appreciated] greater understanding that there can be several appointments to attend and be flexible around this, ie allow an hour to attend a scan without having to take annual leave.”
- Source: 2024 Sims IVF survey
