Fertility & baby loss

Fertility issues can affect both men and women, and it can affect those who have children already as well as those who want to create a family.

It's estimated by Fertility Family that 7% of men are infertile, and Gov.uk & NICE report that half of women saw coping with infertility as the most upsetting experience of their lives. While this is a very personal issue, the support that your employer and those around you can provide makes a real difference in helping you to cope and come to terms with infertility and any steps you make take with fertility treatment.

Some of the common reasons for infertility are:

• Poor sperm or egg quality
• Ovulation problems
• Endometriosis
• Polycystic ovarian syndrome (PCOS)
• Fallopian tube problems
• Unexplained fertility problems
• Age
• Drug related infertility

More information

• Tommy's provide a wealth of additional information on fertility treatments, and in some cases what you may be able to do to help improve your chances of having a baby
• The NHS website provides further information on infertility including the causes, getting a diagnosis and potential treatments
• Bupa provide a comprehensive guide to fertility treatments

What is IVF?

In vitro fertilisation (IVF) is perhaps the most commonly known form of fertility treatment. This is a method of assisted conception that can be used by couples to carry a child. It involves the collection of an egg, which can sometimes be a donor, and this is then fertilised using sperm in a lab. Once the egg is fertilised successfully, it's called an embryo. The embryo is returned to the womb to grow and develop.

Before getting to this point, a couple will undergo various tests, and this will help determine the options for IVF which can include sperm donation, egg donation and surrogacy.

IVF is an option for same-sex couples, when a couple is having difficulty getting pregnant naturally, and if you want to get pregnant as a single parent. Tommy's provide a useful guide for those having difficulties getting pregnant naturally.

How IVF works

There are several stages to IVF treatment which can take between 4-6 weeks for a complete cycle. 

It starts with hormone injections to stimulate egg production in the woman which are then collected under a sedated procedure. This period of time can leave you feeling unable to work and your employer should support you by supporting adjustments to your working arrangements or time-off when necessary. You should also be supported with time-off for appointments which may involve both partners. Once an egg is fertilised and begun its development as an embryo, it will then be transferred into the mother's womb. This final period of treatment can be an especially anxious time until a pregnancy test can be taken.

Who provides treatment

The NHS offers three full cycles of IVF treatment for those that are eligible, but there are criteria that need to be considered. There is a waiting list, which can vary depending upon where you live in the country. 

Private treatment is expensive, and costs vary, but it can cost between £4-8,000 on average, and in cases of surrogacy this could be as much as £20-30,000. For most, this is a significant financial constraint and can be a source of stress leading to poor mental wellbeing.

More information

• Tommy's provide an in-depth guide to IVF - the process, the risks and success rates and much more
• The NHS website provides further information on IVF
• Bupa provide a comprehensive guide to fertility treatments

The effects of fertility treatment on wellbeing

Fertility treatment can have a multilayered impact on wellbeing.

• Financial - whether you're entitled to NHS funded treatment depends on your circumstances and where you live. Each NHS partnership has slightly different criteria, so things that can be taken into consideration include whether you have children, your age, and what your body mass index is. Private treatment could cost £4-8,000 on average which can place a strain on financial wellbeing. 
• Emotional - 9 out of 10 people on fertility treatment journeys experience mental health challenges, including difficulty concentrating, anxiety, stress and depression. In some cases, some people may need to fund specialist counselling themselves as not all clinics offer this. There can also be waiting periods with anxiety building up over time.
• Social - 78% of those that undergo fertility treatment say they have withdrawn from society. Many say they struggled hearing news of pregnancy in their personal lives. Workplaces can exacerbate this as announcements can happen unexpectedly. Some workplaces are producing guidelines which help people share their news in a joyful way while being respectful to other colleagues.
• Physical - treatments can be invasive with injections that may need to be self-administered or going in and out of clinics. There can also be side-effects such as hot flushes, feeling down, and the impact that hormone changes can have on the individual and on those around them.

It's therefore important to consider the support around you when undergoing fertility treatment and having some plans in place to help you cope or manage some of the potential impacts. These can include lifestyle changes, keeping active and healthy, and sharing how you feel so you're not alone in the process.

Some articles which may help:

Managing depression

A guide from the Bank Workers Charity on recognising depression, managing it, and getting help when you need it.

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Relationship support

A post from the Bank Workers Charity on the relationship support available for adults and young people.

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Reducing stress & building resilience

Tools from the Bank Workers Charity to help you improve your mental wellbeing and protect from the effects of stress.

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The hidden experience

Going through infertility treatment can impact all areas of life. What we know is that talking helps us to process feelings and experiences we may be having. But there are some experiences which are talked about less, or we may feel we need some guidance on how to have a conversation when we know someone is experience fertility issues. We'll look at these experiences in this section.

• Secondary infertility is where someone has one or more pregnancies in the past but are having trouble conceiving now. It can be just as devastating as primary infertility. There can be that added layer of feeling not understood, or people may make comments with the best of intentions but not really understanding - experiencing secondary infertility isn't about the size of the family you have.
• People may say nothing which can feel very isolating. In general, we talk less about surrogacy and adoption than we do about IVF, and a common reaction when we don't really understand is to remain silent. This can leave someone feeling lonely, and like they're not understood. It can also be that someone doesn't know what to say, or how to ask more. It's important and ok to show that you care in these situations.
• Something we don't often think about, but people may continue to experience feelings they have had about their fertility - a type of pregnancy Post Traumatic Stress Disorder (PTSD). The frequency of undergoing and waiting for the pink line on a pregnancy test can be an especially anxious and emotional time, and it's the same feeling that someone can re-experience waiting for a Covid test.
• Well intentioned advice is not usually asked for, but we often fall into the trap. Saying things like "I know someone who did xyz to get pregnant" may be well intentioned, but it compounds feelings for that person that they're the one at fault - there's something I'm not doing. It minimises what is a complex situation - both fertility treatment, and infertility itself are both complex.

Baby & pregnancy loss

Whether you're going through natural conception or fertility treatment, many people can experience a pregnancy loss. No matter how it happens, anyone experiencing a loss may need support.

• Miscarriage is the most common form of loss affecting 1 in 4 pregnancies. This most often occurs during the first trimester where they may not have shared their pregnancy news with anyone, or to a small group of others. Research shows that a month on from a miscarriage, a third of women will suffer from Post Traumatic Stress - and a quarter will deal with mild to moderate anxiety. Miscarriage is legally defined as happening before 24 weeks of pregnancy. Although having 3 or more miscarriages in a row is uncommon, it affects around 1 in 100 women in the UK.
• 1 in 225 pregnancies result in a still birth or late-term loss after 24 weeks of pregnancy. This can be one of the most devastating experiences to go through, and the body and mind are geared up towards being a parent. Birthing parents are entitled to take a full period of maternity/shared parental leave (when in qualifying employment). Co-parents are also entitled to take parental leave or bereavement leave too.
• 1 in 3 UK women will have an abortion by the age of 45. This can be difficult mentally as well as physically, and abortion can be because of medical reasons or trauma. It's important that we protect women's access to abortion service and to ensure they receive all the information they need to decide what is best for their situation.
  
• There are other forms of loss too, such as ectopic pregnancy which is where the fertilised egg attaches itself somewhere outside the uterus, and molar pregnancy which is a rarer complication where the fetus doesn't form properly in the womb.
• There can be complications during or after birth, or premature birth which raises the risk of neonatal death. This is where a baby dies within 28 days after they are born. It can occur because of other infections or congenital issues too, and unfortunately sometimes may be unexplained.

For the birth parent, as well as dealing with the mental effects of loss and bereavement, there's a physical element too. This can include trips to see medical professionals, medications and hormonal and bodily changes as a result of pregnancy. It's important to take time to look after yourself if any of the above is happening to you. In the event of a miscarriage, you're not entitled to maternity leave, but you can still take time off through your employer's sickness and absence policy.

Those around you may also experience issues relating to the loss too. Not everyone processes the grief of loss in the same way. Partners may want to feel strong and supportive and not show their feelings. It can be a hard time, and we'd recommend anyone experiencing baby loss to seek support.

More information

• Tommy's provide information and support for anyone who has experienced the loss of a baby, including miscarriage, stillbirth, neonatal death, or other reasons.
• The Miscarriage Association offer lots of support, information and details on the support you should expect if you experience pregnancy loss.
• The NHS offer information and support on miscarriages, stillbirths and other pregnancy related loss.

Support from the Bank Workers Charity

The Bank Workers Charity can help in the following areas:

• Physical & mental wellbeing - from mental health to caring for your body, the BWC has a range of support and guidance available
• Relationships - our relationships affect our emotional, physical, social and financial wellbeing, so it's important to get support if things aren't going so well. Support includes couples and family therapy, plus much more
• Financial matters - from managing your money to debt support, the BWC have a range of support and guidance available. Plus they can help with cash grants when you need it most
• Work support - getting a good balance between work and life can be difficult, so it's good to find out about your rights and what support is available to you
• Plus much more - including support for carers and getting specialist support pre-retirement

Support from your employer

Issues relating to fertility, pregnancy and baby loss are challenging for those experiencing them. A good manager should be supportive and create an environment where you feel free to share how you're feeling, what you're going through and seek support. We don't expect managers to be experts, but we do expect them to have understanding, to help you by giving you the time and support you need, and to make empathetic decisions.

So, what support should you expect from your employer?

• Time off for medical appointments - this may be a mix of paid or unpaid leave, or the flexibility to work around your appointments or work the time back elsewhere in your week. When it comes to fertility treatments such as IVF, there will be several medical appointments and procedures, so your manager should work with you to ensure you're able to complete the process.
• Absences related to pregnancy should not be used for the purposes of your employer's standard absence management process.
• Bereavement and compassionate leave should you find yourself in the unfortunate circumstances of experiencing a miscarriage.
• Maternity/parental leave is a legal right (subject to qualifying employment periods) in the event of you experiencing a stillbirth or neonatal death.
• Pregnancy related risk assessments should be conducted to understand the risk to you and your baby when working. This can help you to reduce risk factors which may affect whether you're able to carry a pregnancy to full-term without complications.
• Most large employers offer some form of Employee Assistance Programme to help you access wellbeing support. This often includes access to counselling and other mental health services. We've listed the EAP details for Lloyds Banking Group (LBG) and TSB in the contacts section of this guide.

Get support from Accord

We're able to help you navigate your employers' policies in relation to pregnancy, fertility treatments and baby loss.

• Find and contact your local Accord rep or your local Accord officer
• Considered using your employer's private healthcare scheme? You may be entitled to claim back 50% of the excess you pay. Check if you're eligible and make a claim online
  
• Find information in our help centre on your employer's policy for sickness & absence, parental leave or other types of leave.

Support & contacts

There are many sources of support available to you, we'll start with general support:

• LBG’s Employee Assistance Programme (Validium): 0800 9700 100
  
• TSB's Employee Assistance Programme: 0800 0856 348
• Bank Workers Charity: 0800 0234 834 or https://www.bwcharity.org.uk/

Fertility & pregnancy loss support

• Fertility network: https://fertilitynetworkuk.org/
• Tommy's: https://www.tommys.org/
• Miscarriage Association: https://www.miscarriageassociation.org.uk/
• British Pregnancy Advisory Service: https://www.bpas.org/
• HFEA: https://www.hfea.gov.uk/
• Tommy's provide an in-depth guide to IVF - the process, the risks and success rates and much more
• The NHS website provides further information on IVF
• Bupa provide a comprehensive guide to fertility treatments

Mental health support

• Mind mental health charity: https://www.mind.org.uk/
• Samaritans: 116 123 or https://www.samaritans.org/
• NHS Every mind matters

And remember, if you’re an Accord member and need a chat about support at work, call the helpline on 0118 934 1808.

Find more mental health related articles on our website.