If fertility treatment is healthcare, why are people using their holidays to access it?
Patients carry most of the burden of navigating work and fertility treatment themselves. They arrange early-morning scans before work, make up hours in the evenings after work, and decide, case by case, whether or not to tell their manager. File picture
One in six of the global adult population experience infertility challenges, with both men and women similarly affected. In 2024, Ireland began to treat infertility as a health issue, with the State now funding a round of IVF for patients who meet specific criteria.
Yet most still have to fit their fertility procedure appointments around their jobs as best they can. Research we have conducted with Reprowork concluded that access to treatment should not depend on who your employer is, and that a national policy framework is needed to offer a baseline of protections and improve equity.
Fertility treatment is expensive, and many patients continue to pay privately after the first IVF round. With no statutory entitlement to time off for treatment, employees rely on annual or sick leave.
Annual leave treats the fertility medical care as personal time, as though treatment were elective. Sick leave implies an inability to work which is not usually the reality.
Rather, time may be needed for blood test appointments where the individual is available for work immediately before and afterwards with no downtime.
For people in temporary, low-paid, shift or manual work, the difficulties in securing discretionary time off to avail of treatment can be particularly acute.
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Many depend on their earnings to finance their fertility treatment, while taking time off may require them to disclose their medical condition to a line manager.
Meanwhile, the needs of men and partners are largely overlooked, because workplace support tends to focus on women undergoing invasive procedures.
Patients carry most of the burden of navigating work and fertility treatment themselves. They arrange early-morning scans before work, make up hours in the evenings after work, and decide, case by case, whether or not to tell their manager.
Disclosure means sharing deeply personal information about their attempts to have a child, something colleagues who conceive without requiring fertility treatment are not expected to do. It also carries career risks, particularly for those on temporary contracts.
Some, therefore, choose to delay or forgo treatment altogether.
Employers, in turn, only recognise the need for support when employees feel safe to ask for accommodations. Thus, the support provided varies considerably between workplaces.
Some employers, particularly larger multinational companies with greater resources, have moved ahead of the law, introducing paid leave for fertility treatment and generous financial benefits to support treatment.
Elsewhere, each request becomes a favour negotiated with a line manager, who may have little room to accommodate it given the day-to-day pressures of performance targets and operational necessities. Voluntary provision on a case-by-case basis turns access to treatment into a lottery.
Disclosure at work is a double-edged sword. In most workplaces, informality prevails with individual accommodations provided to employees that ask for it… or not. Disclosure also highlights the individual need for accommodations that employers may not feel they are able to give, potentially damaging that individual’s career progression or employment security.
For those that decide to keep their treatment private, their employer has little reason to think a policy is needed. Without a policy, employees go on remaining silent. And so the process becomes a vicious cycle.
And employers still bear costs that they may not even recognise as related to fertility treatment: absences go unexplained; line managers are left trying to handle sensitive requests without policy guidance; colleagues may come to see the resulting flexibility for some as unfair; and employers may lose staff who see no alternative but to resign in order to complete their fertility treatment.
State support is needed to help patients and employers co-ordinate treatment and work. Co-ordination across health, employment and social protection is required.
Under the Maternity Protection Act, pregnant employees can attend antenatal appointments without using annual leave or sick leave. However, there is no equivalent for fertility treatment.
This means that, at present, the State funds treatment without protecting employees’ ability to attend medical appointments for treatment. And in this vacuum, both patients and employers are struggling.
This gap could be addressed if the Organisation of Working Time (Reproductive Health Related Leave) Bill 2021 is enacted. The bill proposes paid leave for fertility treatment and protects employees against unfair dismissal for using the entitlement.
Allowing leave for treatment to be taken by the hour, as Malta does, would better reflect the time requirements. A confidential route through HR or a designated contact in the organisation would let employees access their entitlement without having to disclose their personal needs.
Employers would then also know what is expected of them and could concentrate on providing tailored accommodations that would be particular to their own workplaces, rather than ad hoc and piecemeal responses.
Introducing a national statutory baseline through formal legislation and legal entitlements would also mean deciding how costs are shared, particularly for smaller employers, without shifting the burden back onto patients. The time is ripe as Ireland’s approach is still taking shape, so health and employment policy can be designed in parallel.
In September of this year, the Oireachtas Committee on Enterprise, Tourism and Employment heard from a range of voices, including ours, during its scrutiny of the 2021 bill. This year’s European Fertility Week’s core focus is on Fertility@Work, a reminder that this work is unfinished.
Our Government has the opportunity to now build on what the committee heard and to bring forward legislation to ensure that all fertility patients can access treatment while in employment, either by progressing the bill or through proposals of its own.
- ReproWork is a collaboration between Professor Marian Crowley-Henry and Dr Valentina Paolucci from Maynooth University School of Business and Dr Louise Glover, Orla O’Leary, Professor Cathy Allen and Dr Róisín McConnell from Merrion Fertility Clinic. This collaboration focuses on fertility treatment, work and equity.
- ReproWork will hold a dissemination event on December 17 at the Phelan Room, National University of Ireland — register here
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