Supporting Employees Through Fertility Challenges

Many employees going through IVF, miscarriage or other fertility challenges are not operating under a clear framework, but under a lottery.

In the UK qualitative studies, support often hinged on a single factor: who their line manager happened to be. Some managers quietly flexed hours, protected performance ratings and treated appointments as routine health needs. Others insisted on annual leave, questioned commitment or suggested that treatment was a “personal choice”. The policy landscape behind this variability is thin. Fertility or assisted reproduction policies were described as uncommon compared with maternity or paternity frameworks, and specific fertility leave as rare. Most respondents in one UK survey reported using annual or sick leave for treatment.

On paper, HR may see compassionate intent. On the ground, employees see risk and inconsistency.

When policy is silent, power speaks.

Across studies of infertility and reproductive loss at work, employees described “relying heavily on line managers’ discretion” for any adjustment: time off for procedures, flexibility around medication side-effects, time to recover from miscarriage or failed cycles. In some public-sector and university settings, explicit policies reduced the need to “beg” for time off. Where no such policies existed, support became a negotiation shaped by power asymmetries, local workload pressures and managers’ personal beliefs about fertility.

Team norms then amplified or constrained what managers felt able to offer. In some teams, IVF was framed as equivalent to any other health condition; in others, colleagues saw it as elective, and questioned why workload should be redistributed.

This distinction matters.

Perceptions of fairness surfaced repeatedly. Without organisational guidance, covering appointments often meant informal favours: a colleague staying late, picking up clinics, reworking rotas. Where colleagues doubted the legitimacy of fertility treatment as a health need, resentment followed, and managers pulled back to avoid conflict. Leadership emphasis on high performance and presenteeism reinforced this dynamic, making time off for treatment look like an exception that had to be justified rather than a foreseeable, manageable demand on capacity.

The predictable response from employees was silence.

Interviewees talked about concealing treatment, rearranging appointments to evenings, or appearing at work straight after invasive procedures to avoid signalling “low commitment”. Those experiencing miscarriage or failed treatment often had no formal route to compassionate leave and were directed towards sick or annual leave if they disclosed at all. Others chose not to disclose, trading recovery for perceived career protection.

From an HR vantage point, that silence can easily be misread as absence of need.

The complication is that this lottery is emerging just as fertility support is being rebranded as a strategic asset.

Industry and legal analyses describe employers as playing an “increasingly pivotal role” in expanding access to fertility care. In the U.S., 42% of employers now offer some form of fertility benefit, up from around 30% in 2020, with roughly a third to half of large employers covering medication or IVF. WorldatWork data links these benefits to engagement, loyalty and talent attraction: when employees receive fertility benefits, 81% report being more engaged and productive, 96% report greater loyalty, and two-thirds say they have taken or considered a job because of better reproductive and family health support.

Family-building support has become “a defining priority” in benefits strategy, central to how many employees assess workplace value.

For UK HR leaders, this creates an awkward contrast: rising global expectations and persuasive ROI narratives on one side; highly discretionary, often invisible practice on the other. Simply importing a fertility benefit into a context where support already depends on managerial goodwill risks hardening, not solving, inequity.

If only those who feel safe disclosing to supportive managers can fully use a generous scheme, the gap between policy and lived reality widens.

The more promising route is to reframe fertility from a niche perk to a routine health need that is handled with the same predictability as other serious medical conditions.

Formal policies are not a cure-all, but the research is clear that they change the starting point of the conversation. Where organisations had explicit fertility or assisted reproduction policies, employees reported “clearer entitlements and less need to ‘beg’ for time off”. The key design move for HR is to pair any benefit with guardrails that reduce arbitrariness while still allowing local judgement.

Three areas deserve particular attention.

First, visibility and scope. Many organisations have detailed maternity provisions but nothing on IVF, surrogacy, adoption processes, miscarriage or failed treatment. A concise fertility and reproductive loss policy that sets out basic entitlements to time off for appointments, recovery and counselling – regardless of gender, sexual orientation or relationship status – turns contested exceptions into anticipated events. Including reference to emotional impact, not just procedures, signals that mental fitness during fertility journeys is legitimate ground for support.

Here, digital mental fitness tools can do quiet but important work. Platforms like Leafyard, framed around mental fitness rather than crisis alone, give employees confidential routes to manage the chronic stress, sleep disruption and anxiety that often accompany fertility treatment. A large digital wellbeing library and microlearning on stress, sleep and resilience allow people to build coping skills in short bursts, without needing to disclose anything to their line manager.

Second, manager capability and boundaries. Removing discretion entirely is neither realistic nor desirable; fertility journeys vary too widely. But unbounded discretion is what produces the lottery. HR can narrow the range of outcomes by issuing practical guidance: example phrases for conversations, default arrangements for covering appointments, and clear reassurance that treating fertility like other health needs is not “special treatment”. Mental Health First Responder training, of the kind embedded within Leafyard, can equip managers and peers to spot early warning signs of distress and signpost support without turning them into counsellors.

This is where a preventative, behavioural-science-led approach to mental fitness helps. When managers see tools like guided video coaching, structured journalling and five-day experiments on sleep or stress—as used in Leafyard’s structured programmes—as part of normal performance support, it becomes easier to extend the same logic to colleagues in fertility treatment, rather than seeing them as exceptions to be indulged.

Third, communication and fairness narratives. Colleagues’ perceptions of fairness are a real constraint. HR needs to own the story about why fertility support sits within equity and inclusion, not outside it. That means explaining that infertility is recognised as a disease of the reproductive system, that access to treatment is uneven, and that some groups – particularly women and LGBTQIA+ employees – face higher barriers. Positioning fertility support alongside menopause, hormonal health and other reproductive-health initiatives reframes it as part of a coherent approach to life-stage and health-based needs.

The analytics piece matters as well. Behavioural analytics and board-ready reports, of the sort Leafyard provides for mental health, can help HR show that well-designed, preventative support reduces absenteeism and presenteeism linked to fertility stress, rather than just adding cost. Being able to translate engagement with mental fitness resources into pounds-and-pence savings—illustrated in client case studies such as Hill Dickinson—gives HR a stronger platform when negotiating policy changes or expanded benefits.

None of this resolves the underlying ethical tensions between privacy, fairness and operational capacity. But it does change who carries them.

When HR treats fertility as a routine health need – backed by clear policy, explicit norms, and manager support – employees are no longer forced to negotiate their legitimacy case by case. The “support lottery” does not disappear, but its stakes reduce as the baseline rises.

A practical next step is an internal audit: map where fertility and reproductive loss currently sit in your policies, how much depends on individual managers, and where fairness tensions are surfacing informally. Then choose one or two specific shifts – a basic fertility policy, manager guidance, a confidential mental fitness platform – that move your organisation away from discretionary exception-handling and towards predictable, legitimised support.

When fertility journeys are anticipated in system design rather than left to private negotiation, people talk earlier, managers act with more confidence, and the culture moves closer to the equity most HR leaders are aiming for anyway.