Statistics on infertility can, at times, feel staggering. According to recent studies, between 12% and 15% of couples in the United States are unable to conceive after one year of trying to conceive. Globally, 48.5 million couples experience infertility.
Infertility: a social stigma
Statistics like these feel so overwhelming because of the stigmas often associated with infertility, which often create feelings of shame and failure. Those stigmas have several roots. Because many cultures view starting and raising a family as a societal norm, the inability to do so can create feelings of inadequacy. In the worst instances, some dealing with fertility issues can become the victims of discrimination. Not surprisingly, rather than face those stigmas, many choose to keep their struggles secret, which leads to further feelings of isolation.
Infertility affects both men and women equally, with approximately one-third of the causes stemming from male issues, one-third from female issues, and one-third from a combination of both. Women, however, more often feel the impact of infertility more acutely, either through social or self-stigmas that leave them feeling devalued.
Infertility presents diversity, equality, and inclusion issues
The situation becomes even more critical for women of color, particularly Black women. Studies show they're twice as likely to experience infertility as white women, but almost half as likely to seek treatment, in part because of more difficulty accessing fertility care.
Infertility also presents critical challenges for the LGBTQIA+ community. Many are denied coverage for IVF treatments, for example, because health plans often require a medical diagnosis of infertility, which is defined in heterosexual terms, to prove that the individual or couple cannot conceive children through sexual intercourse. As a result, many have felt excluded from conversations not only about the stigmas of infertility but also the available treatments.
Supporting individuals experiencing infertility
Fortunately, leading companies have begun to offer help—clinical, emotional, and financial—to those dealing with infertility. In this blog, we'll not only cover some infertility basics but also look at ways that you can help your employees navigate this very personal journey by destigmatizing infertility in the workplace. We'll discuss:
- What infertility is and its causes
- Infertility prevalence
- Why infertility is stigmatized
- The effects of infertility stigma
- The impact infertility has on employees in the workplace
- How to destigmatize infertility in the workplace
What is infertility?
As mentioned above, infertility is the inability to conceive after 12 months of regular unprotected sexual intercourse. The definition differs slightly for women aged 35 and over because fertility steadily decreases with age. For these women, infertility is the inability to conceive after six months of unprotected sex.
Infertility can be classed as primary or secondary infertility. Primary infertility is when a pregnancy has never been achieved by an individual. Secondary infertility is when someone cannot conceive or carry a baby to term after having given birth at least once previously.
What causes infertility?
Infertility is often a complex issue, and a multitude of factors can contribute to a diagnosis simultaneously. In 30% of cases, infertility is unexplained, with no determinate cause found. However, there are a range of well-known causes of infertility, some of which can be resolved with medical treatment, some of which can be overcome with fertility assistance, and some of which cannot be treated.
Female infertility can be caused by various factors that affect the reproductive system. Some common causes of female infertility include:
- Ovulatory disorders: Problems with ovulation–the release of eggs from the ovaries–can lead to female infertility. Conditions such as polycystic ovary syndrome (PCOS), hormonal imbalances, and thyroid disorders can disrupt normal ovulation.
- Fallopian tube issues: Blockages or damage to the fallopian tubes can prevent an egg from meeting the sperm as is needed for conception. This may be due to pelvic inflammatory disease (PID), endometriosis, or previous pelvic surgery.
- Uterine problems: Abnormalities in the uterus, such as polyps, fibroids, or structural abnormalities, can interfere with implantation or the ability of a fertilized egg to develop.
- Endometriosis: This is a condition where tissue similar to the lining of the uterus grows outside the uterus. Endometriosis can cause scarring, adhesions, and inflammation, affecting fertility.
- Age: Female fertility declines with age, especially after the age of 35. As a woman gets older, the number and quality of her eggs decrease, making it harder to conceive.
- Pelvic Inflammatory Disease (PID): Infections, such as sexually transmitted infections (STIs) including chlamydia and gonorrhea, can cause inflammation and scarring in the reproductive organs, leading to infertility.
- Thyroid disorders: Problems with the thyroid gland can affect the menstrual cycle and disrupt fertility. Both hypothyroidism and hyperthyroidism can be associated with infertility.
- Lifestyle factors: Certain lifestyle factors can impact fertility, such as smoking, excessive alcohol consumption, obesity, and extreme exercise.
- Genetic factors: Some genetic conditions can affect fertility. For example, women with Turner syndrome may experience ovarian dysfunction.
Male infertility can be attributed to various factors that affect sperm production, quality, or delivery. Some common causes of male infertility include:
- Low sperm count (Oligospermia): A low sperm count can decrease the likelihood of fertilization. This can be caused by factors such as hormonal imbalances, infections, or genetic conditions.
- Poor sperm motility (Asthenospermia): Sperm needs to swim effectively to reach and fertilize an egg. Poor sperm motility can result from various factors, including genetic abnormalities, infections, or testicular overheating.
- Abnormal sperm morphology (Teratospermia): Sperm with irregular shapes may have difficulty penetrating the egg. This can be due to genetic factors, hormonal imbalances, or environmental influences.
- Ejaculation disorders: Problems with ejaculation, such as retrograde ejaculation (when semen enters the bladder instead of emerging through the penis) or premature ejaculation, can contribute to male infertility.
- Varicocele: A varicocele is a swelling of the veins that drain the testicle. It can lead to decreased sperm production and quality. A varicocele can be treated with a surgical procedure.
- DNA fragmentation: DNA fragmentation refers to the presence of breaks or damage in the DNA strands of sperm. Excessive fragmentation can affect the sperm's ability to fertilize an egg.
- Obstruction of the reproductive tract: Blockages or obstructions in the tubes that carry sperm can prevent them from being ejaculated. Blockages can result from infections, surgery, or congenital conditions.
- Hormonal imbalances: Disorders affecting the hormonal regulation of sperm production, such as problems with the pituitary or thyroid glands, can contribute to male infertility.
- Testicular factors: Conditions that affect the testicles, such as undescended testicles, testicular injury, or the presence of tumors can impact sperm production.
- Environmental factors: Exposure to certain environmental toxins, chemicals, or radiation can harm sperm production and quality.
- Lifestyle factors: Habits such as smoking, excessive alcohol consumption, and drug use can negatively affect sperm production and function.
- Age: While not as pronounced as in females, male fertility can decline with age. Advanced paternal age has been associated with a higher risk of genetic abnormalities in offspring.
- Genetic factors: Some genetic conditions can affect male fertility, such as Klinefelter syndrome, where a man has an extra X chromosome.
How common is infertility?
If the statistics below seem surprising, it's because the stigma and secrecy surrounding infertility often obscure just how common it is:
Percentage of married women 15-49 years of age in the U.S. who are infertile: 0 births: 19.4%; 1 or more births: 6%
About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems.
12.2% of women aged 15-49 have used infertility services
33% of American adults report that they or someone they know has used some type of treatment in order to try to have a baby.
U.S births via assisted reproductive technology more than tripled between 1996 and 2016.
Why is infertility stigmatized?
Infertility stigma can arise for many reasons, which can differ depending on geographical location, culture, and socioeconomic status. For example, infertile women experience the negative effects of childlessness to a greater degree in developing countries than in developed societies. Infertility stigma can also vary according to gender, with infertile women and men’s experiences of infertility-related stigma being similar in some regards but also vastly distinct.
Social perceptions play a significant role in contributing to infertility stigma. For example, in many societies, there is a strong emphasis on biological parenthood and the notion of the nuclear family. This is often perpetuated by media representations of families and can contribute to unrealistic standards that infertile individuals are compared to and also internalize.
Societal expectations and pressures regarding parenthood can further contribute to the stigma surrounding infertility. Couples who cannot have children or are delayed in becoming parents due to infertility may face scrutiny and judgment, reinforcing the idea that parenthood is an expected and necessary life path.
Infertility stigma can also be derived from a much smaller subset of people, including an individual’s close family. Familial attitudes related to infertility may be because some parents may have strong expectations for their children to provide them with grandchildren. The desire to see the family grow and pass on traditions can create added pressure on couples facing fertility challenges and make them feel like they aren’t meeting their familial duty.
In cultures where family lineage and the continuation of the family name are highly valued, there may be intense pressure on individuals or couples to conceive and produce an heir. Infertility may be viewed as a threat to the continuity of the family line, leading to heightened expectations and psychological distress.
Traditional gender roles can play a role in the stigma surrounding infertility. In some cultures, infertile women, in particular, may face additional scrutiny and blame, reinforcing gender-based stereotypes and contributing to feelings of shame.
According to a study published in BMC Women’s Health, stigma affects women significantly. Chinese women usually have high family decision-making power. This coupled with the importance placed on fertility and the ability to bear children, means that according to society, “childlessness is always the women’s fault”. As a result, infertile women experience moderate to high levels of female infertility stigma in China and suffer not only personal grief due to their circumstances but also rejection and economic deprivation.
Misconceptions and lack of understanding
Lack of awareness and understanding about the causes of infertility can contribute to misconceptions and judgment. People may make assumptions about the reasons for infertility, attributing it to personal choices or behaviors, without considering the complex medical and emotional factors involved.
Effects of stigma related to infertility and infertility treatment
Infertility stigma can have profound and wide-ranging effects on individuals and couples, impacting various aspects of their well-being, social relationships, and even the dynamics within their household.
Mental health issues
Infertility in itself can cause mental health issues, with as many as 52% of infertile women experiencing anxiety and depression. However, infertility stigma and the way that individuals are perceived and treated by others as a result of their diagnosis can further contribute to negative emotions and psychological distress. Infertility stigma can cause more severe anxiety and depression-related symptoms including social withdrawal.
Infertility stigma may lead individuals to internalize a sense of inadequacy or failure, particularly if they perceive their worth to be tied to traditional notions of family and parenthood. This can be perpetuated by social reactions to the person’s infertility.
For example, in Nigeria, if a woman fails to conceive, she may be taunted by her in-laws, neighbors, and relatives. In rural areas of Bangladesh, infertile women are strongly humiliated and belittled. As well as drastically lowering their self-esteem, this treatment also leads to feelings of guilt and role failure, and further self-stigma.
Infertile individuals, including men and women seeking infertility treatment, often feel socially excluded as a result of the social stigma attached to their circumstances. People experiencing infertility may choose to isolate themselves from social interactions to avoid judgment, pity, or uncomfortable questions, especially in social circles that place a strong emphasis on traditional family structures.
The fear of being stigmatized can lead to a self-imposed withdrawal from friends, family members, and social gatherings. Even when not self-excluding, infertile individuals can still feel isolated. For example, the social stigma of infertility can make it challenging for individuals to discuss their experiences openly. Friends and family, unsure of what to say or how to offer support, may avoid the topic altogether.
Infertility stigma can contribute to increased tension within relationships, with infertile women being the most affected. A study of infertile women in Nigeria found that nearly have of those included in the study were subject to domestic violence due to their infertility status.
Infertility stigma and its impact can contribute to divorce rates.A study of 598 partners established that infertility was accepted as a reason for divorce in 13% of infertile participants.
What impact does infertility have in the workplace?
The secrecy around infertility also extends to the workplace. While childbirth often leads to a celebration in the office, the same can't be said for those who suffer from infertility. As a result, fertility shame gets compounded in the workplace. A recent survey showed that 50% of women in the UK hid their infertility treatment from their employer out of fear their employer would think less of them. In addition, 40% voiced concerns about the negative effects of their infertility on their careers.
The impact of infertility on birthing parents often shows up in myriad ways at work. Among the most common include:
First and foremost, infertility can have a devastating emotional impact, causing a range of negative emotions and leading to infertility-related stress. A 2016 Fertility Network study found that 90% of people with fertility problems or undergoing treatment were depressed and 42% had thoughts of suicide. The combined emotional, physical, and financial strain of the treatment process often results in the need for time off work.
Infertility can also affect an individual physically. Some causes of infertility, such as endometriosis and varicoceles can cause pain, but infertility treatments can also take a toll on the body. Many infertile women who undergo IVF, for example, find that hormone injections cause discomfort and bloating as their ovaries grow to increase egg production. The effects of which can also impact sleep, leading to low mood, lack of concentration.
Fertility treatment is a rollercoaster, and many find it physically and emotionally draining. In a work context, this can mean that employees experiencing infertility or going through treatment may have low energy at work, be in visible pain, have mood fluctuations, and/or be less productive than usual.
Fertility treatment comes at a significant cost. IVF, for example, can cost upwards of $23,000 per cycle, with most couples requiring two or more cycles before achieving a successful pregnancy. Diagnostics, medication, and additional requirements such as donor sperm or intracytoplasmic sperm injection (ICSI) will further increase the cost. The financial burden can impact employees significantly, especially if they have to take unpaid time off work to attend appointments as they undergo treatment.
Work/life balance presents challenges for everyone, but the problems become even more acute for those seeking treatment for infertility. In addition to hectic work schedules, men and women seeking fertility treatment need to find the time to keep those appointments—not an easy task given the time-consuming and unpredictable nature of fertility treatments. Many patients need more than one cycle of fertility treatments, potentially leading to months, if not years, of appointments.
Maintaining this schedule without proper support leads to a host of understandable issues in the workplace, including a loss of concentration, energy, and engagement. That combination can ultimately result in sharp drops in productivity. In the worst cases, highly productive employees may simply decide to leave rather than deal with the strain of work/life balance.
As mentioned earlier, studies show women don't discuss their fertility issues with employers for fear of the possible negative impact on their careers. Whether that fear is real or perceived, it still has consequences. Specifically, those dealing with the emotional, physical, and financial strain of fertility problems may ultimately choose to handle that stress in ways that inhibit their career paths. In other words, their fear of career repercussions may ultimately become a self-fulfilling prophecy as they shy away from actively seeking career advancement.
Quality of life
The World Health Organization defines quality of life as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". Therefore, it is easy to recognize how an infertility diagnosis can impact an individual's quality of life. It can lead to a loss of identity and make them question what they are working toward for the future if their plans for parenthood may not be realized. This inner turmoil may affect their work performance or lead them to want to make changes in their career in a bid to improve their quality of life.
Ways to reduce the stigma of infertility in the workplace
The simplest way to help employees through the strain of infertility involves destigmatizing the issue in your workplace. Here are some recommendations on ways to reduce the stigma of infertility:
Educating your entire organization about infertility and its consequences for all employees—regardless of their paths to parenthood—can have a huge impact on your employees. They'll feel much less inclined to stay silent if they feel confident you understand and support their journey. Education can take the form of specific manager training. You could also develop resource materials outlining how your company can assist men and women seeking fertility treatment.
Take every opportunity to acknowledge those who may be dealing with infertility. Doing so can have tangible results. In the Fertility Network study, employees who said they received more employer support also reported lower levels of distress and less frequent suicidal feelings.
Providing a supportive community
Providing support for those dealing with fertility issues can take multiple forms. Establishing support groups helps employees contend with feelings of isolation. You can offer those support groups by creating a Slack channel for affected employees, for example, or pointing them to public Slack channels. You could also point employees to peer-led groups available through your women's and family health benefits for those struggling with fertility issues.
Infertility support programs also must include support for all employees, regardless of their paths to parenthood. That not only includes men but support for LGBTQIA+ employees. More than 60% of LGBTQIA+ people planning families expect to use assisted reproductive technology and other alternative means of becoming parents.
Inclusive workplace policies
Developing and communicating workplace policies that support employees facing fertility challenges can help them feel less alone and make them feel more comfortable talking about their infertility without fear of judgment. Inclusive workplace policies include those related to time off for fertility treatments, flexibility in work schedules, and accommodations for medical appointments.
Reproductive health benefits
Perhaps nothing issues more of a statement about your company's commitment to those dealing with infertility than offering comprehensive reproductive health benefits that cover employees' costs. More companies than ever now offer fertility and family-building support, and for good reason. The right fertility benefits plan can offer a host of benefits that address many of the issues described above, including:
- Providing clinical, emotional, and financial support
- Building employee loyalty
- Attracting top talent
- Advancing inclusivity
- Improving productivity
Perhaps best of all, despite what some may think, offering fertility benefits often doesn't involve any significant increase in cost for employers.
In addition to family health benefits that cover costs for employees, offering virtual telehealth options also helps destigmatize infertility by addressing some of the critical work/life balance and mental health issues described above. Not only do telehealth options help employees feel less isolated, but they also reinforce your company's commitment to addressing employee needs in ways that best fit their busy lifestyles.
Telehealth makes providers available as needed to answer questions, provide guidance, and offer educational resources. It can increase the number of touchpoints patients have with providers and inspire early interventions for various high-risk factors.
Maven's inclusive approach to fertility
Maven is the world's largest virtual clinic for women's and family health. Our comprehensive Fertility and Family-Building program includes ongoing assessments, proactive check-ins, and consistent touchpoints, helping members identify risks early and prevent costly complications.
The foundation of what we offer is equitable healthcare that encompasses well-being in its entirety. We don’t just focus on achieving parenthood – we prioritize the clinical, emotional, and financial health of your employees throughout the process and beyond. Our inclusive services are designed to break down infertility stigma and empower our patients to make choices about their fertility, all while being supported by our specialists and you, their employer.
Better outcomes for all
When infertility stigma is reduced and employees feel supported in the workplace, it benefits everyone. 33% of members report being able to better manage anxiety and depression due to Maven. 83% of our Family Building members report being more productive during fertility treatment while having Maven’s support, 96% of members are more loyal to employers because they implemented Maven.
Maven's care model is also proven to reduce healthcare spending. In addition to a 2:1 clinical ROI, our offerings reduce the need for costly services like C-Sections and NICU admissions, saving patients and employers thousands in healthcare costs upfront and long term. Our goal is to help couples conceive in the way that's best for them—that's why 25% of members who join our fertility track don't end up needing or receiving treatment.
Schedule a call with our team to see how Maven helps you support your employees on their unique paths to parenthood with fertility benefits that provide 24/7/365 virtual access to family-building specialists.
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