One in six couples in the UK will experience fertility problems. In 2023, over 52,400 patients received fertility treatment, and more than 77,500 IVF cycles were performed, with the proportion of NHS-funded cycles falling steadily from 35% to 27% over the past decade (HFEA, 2025). Most of these patients are now self-funding. Most continue working throughout treatment. Many of them will eventually reach occupational health.

But not always for the right reasons.

The presentation problem

When fertility-related distress arrives at OH, it rarely announces itself. The referral typically cites anxiety, depression, burnout, or unexplained short-term absence, sometimes with a pattern of early-morning appointments, sometimes with an undocumented but significant dip in performance. Fertility treatment, if it is the driver, is often disclosed only when asked directly. Disclosure rates in occupational settings are low, driven by stigma and fear of career impact.

This matters clinically. Peer-reviewed evidence reports anxiety in 18–24% and depression in 11–27% of women undergoing IVF (Hu et al., Scientific Reports, 2025; Li et al., Scientific Reports, 2025). A UK-based study by Payne, Seenan and van den Akker (Journal of Psychosomatic Obstetrics and Gynaecology, 2019), which provides the most directly relevant evidence for this OH context, found that absence of workplace support significantly increased psychological distress in employees undergoing fertility treatment and that most participants reported difficulty sustaining work performance and managing attendance throughout.

The clinical stakes extend beyond wellbeing. A Swedish registry study found that untreated depression or anxiety prior to IVF was associated with substantially reduced odds of pregnancy (AOR 0.58) and live birth (AOR 0.60) (Cesta et al., Fertility and Sterility, 2016). Supporting psychological health during treatment is not only a welfare consideration; it has direct clinical implications for treatment outcomes.

A decade ago, we were having a similar conversation about menopause. Cognitive difficulty, low mood, disrupted sleep and declining performance were all presenting at OH without the underlying cause being consistently identified or named. We are at a comparable moment with fertility treatment. The gap between what is presenting and what is being recognised is significant, and it is a gap that occupational health is well placed to close.

This is a clinical question, not just an HR one

The key clinical principle for OH practice is phase specificity. Fertility treatment is not a single event: it is a sequence of phases, each with distinct functional demands.

During ovarian stimulation, employees are managing daily self-administered injections, frequent early-morning monitoring appointments, hormonal side effects including bloating, mood instability, fatigue and impaired concentration, and, in more serious cases, ovarian hyperstimulation syndrome. During the two-week wait following embryo transfer, physical demands reduce but anxiety is typically at its highest point in the cycle; presenteeism is common, and an employee may appear to be functioning when they are not. A negative result can cause acute psychological distress equivalent to a significant bereavement.

Each phase requires a different OH response. A flexible start time during stimulation is a different clinical recommendation to a full day’s absence for egg collection under sedation, which is different again to the scheduling flexibility and low-key welfare contact appropriate during the two-week wait. Adjustment recommendations that do not account for the treatment phase are likely to be either insufficient or unnecessary.

The OHP’s role is to ask: where is this employee in their cycle, right now?

What good OH practice looks like

There is currently no standardised occupational health guidance for fertility-related referrals. The £217 million estimated annual cost to UK employers of inadequate fertility workplace support (Fertility Matters at Work/Make an Impact CIC, 2024) reflects the scale of this gap, in both policy and clinical case management. Only 27% of UK employers have any fertility-related workplace policy (CIPD, 2023), and 87% of managers have received no training on fertility issues (Fertility Matters at Work, 2025).

Good OH practice in this context is grounded in functional assessment. The written management report should document current and anticipated functional limitations by treatment phase and make specific, quantified adjustment recommendations. Vague recommendations, such as “restricted duties”, without specification, are not clinically useful. The OHP’s role is to be precise: which tasks, which adjustments, for which phase, and for how long.

Where relevant, a brief validated mental health screen is appropriate. Depression and anxiety are prevalent and under detected in this population. Employees on second or third cycles may carry cumulative psychological burden not visible from the current presentation. Cycle history is clinically and prognostically relevant.

Disclosure is also a clinical consideration. Many employees have not told their line manager they are in treatment. The OHP can explore whether managed disclosure would be helpful, without making that decision for the employee.

Navigating the legal context

OHPs are not legal advisers, but clinical awareness of the legal framework shapes good practice. There is no specific protected characteristic for fertility treatment under the Equality Act 2010. However, relevant provisions exist: sex discrimination considerations may arise in how treatment-related requests or absences are managed; disability provisions may apply where treatment has caused or exacerbated significant and long-term psychological difficulty (typically lasting, or expected to last, 12 months or more); and from the point of embryo transfer, legal protections equivalent to pregnancy apply.

The OHP’s role is to hold this awareness, not to make legal determinations. Noting the embryo transfer date in case-records is good clinical practice; it informs adjustment planning and calibrates recommendations to the specific demands of this stage. Where an employee raises questions about their rights or how their requests have been managed, the OHP can acknowledge these in consultation and suggest the employee discusses them informally with HR. The written OH report stays clinical: functional limitations, adjustments, prognosis.

In practice, HR may approach the OHP to seek a clinical view on whether the disability threshold appears to be met. The OHP’s role here is to provide a clinical opinion on functional impact; the legal analysis remains with HR and, where needed, legal advisers.

The clinical opportunity

The absence of standardised OH guidance for fertility treatment is both a gap and an opportunity. OHPs who develop phase-aware, functionally grounded practice in this area will conduct better assessments, make more targeted recommendations, and support employees through one of the most clinically and psychologically demanding experiences they are likely to face during their working lives.

It begins with one additional question in every relevant referral:

‘Are you currently undergoing, or have you recently undergone, any fertility treatment?’

Disclosure rates in occupational settings are low. Asking directly, and creating a consultation environment where disclosure feels safe, is the first clinical intervention.

The fertility toolkit for OH professionals can be found here: Fertility Toolkit for OH Practitioners – iOH – The Association of Occupational Health and Wellbeing Professionals