For decades, British workplaces have measured employee wellbeing in days off. A bout of flu, a chest infection, a sprained ankle: a few sick notes, a fit-to-return form, and the matter is closed.
Yet a growing body of clinical evidence, and a steady drumbeat of employment tribunal cases, suggests that this tidy framework is wholly unfit to deal with the reproductive health challenges that thousands of British workers quietly navigate every day.
Fertility treatment, pregnancy loss and the menopause are, in the words of one consultant, fundamentally different beasts. They cannot be cleared by a course of antibiotics. They are not, in any meaningful sense, temporary. And, crucially for employers, the cost of getting the response wrong is no longer simply a matter of compassion, it is a matter of retention, productivity and, increasingly, legal exposure.
The conventional model of workplace illness assumes a hurdle that the body eventually clears. IVF, miscarriage and menopause do not behave that way. They are tied to identity, to the future a person had imagined for themselves, and to a biological transition that can play out over months or years rather than days.
A miscarriage is, in effect, a bereavement requiring emotional processing alongside physical recovery. IVF involves systemic hormonal shifts that are unpredictable in both timing and intensity. The menopause, increasingly recognised as a workplace issue in its own right, brings vasomotor and cognitive symptoms that can persist for the better part of a decade. None of these is a short-term medical issue, and treating them as such is the first mistake too many British employers continue to make.
Anyone who has sat through a difficult conversation at work knows the British instinct to reach for the silver lining. “At least you can try again.” “Everything happens for a reason.” “At least it was early on.” Said with the best of intentions, these phrases can land with extraordinary cruelty.
Clinically, “trying again” is never a guarantee. For a patient with low anti-müllerian hormone (AMH) levels, the marker used to assess ovarian reserve, each failed cycle or miscarriage represents a biological window that is closing rather than reopening. The phrase also ignores cumulative trauma: the physical and hormonal exhaustion that builds with every attempt. By looking to a hypothetical future, the colleague risks dismissing the very real grief and recovery happening in the present.
The advice from clinicians is simple. Drop the platitudes. Replace them with something direct: *”I’m sorry you are going through this. I’m here if you want to talk, or if you need anything.” Managers should go a step further, focusing on the practical: “I’m happy to adjust your workload and cover meetings so you can focus on your appointments and wellbeing.”
The principle is straightforward. Treat the situation as you would any other specialised medical need. Grant the employee the autonomy to attend appointments or take rest without making them justify themselves repeatedly. The goal is comfort and clarity, and reassurance that their career is not on the line because of their biology.
There is a hard-edged business case here, too, and it begins with cortisol. Sustained workplace stress and the fear of stigma trigger the chronic release of cortisol and adrenaline, the body’s fight-or-flight hormones. These are significant disruptors of an endocrine system that is already under intense pressure during IVF, miscarriage or menopause.
Elevated cortisol interferes with the body’s ability to regulate other essential hormones. For a perimenopausal employee, stress-induced inflammation can physically worsen the frequency and severity of hot flushes and night sweats. For an IVF patient, the same chemistry can sabotage the very treatment the company is, in many cases, helping to fund.
Stigma compounds the problem. When an employee feels they must conceal a miscarriage or a failed cycle to protect their professional standing, the body remains in a state of high tension. The parasympathetic nervous system, the state required for tissue repair and hormonal balancing, never gets a chance to take over. Patients delay seeking help, skip recovery days, and a standard recovery becomes a prolonged health crisis. The cost shows up later, on the absence rota and in the resignation letter.
Among the most misunderstood symptoms is so-called brain fog. During menopause or a high-intensity IVF cycle, the brain’s oestrogen receptors, which govern how the brain uses glucose for energy, are effectively starving or being overwhelmed. The result is a genuine power failure in the regions responsible for memory and executive function.
When a colleague undergoing fertility treatment loses a word mid-sentence or drifts in a meeting, this is not distraction or reduced effort. It is a physiological response to a hormonal storm. Managers who recognise this, and who quietly adjust expectations rather than file it under “performance concern”, will hold on to talented people that less informed competitors will lose.
Reproductive health, employers should understand, is rarely a day-of event. It takes roughly 90 days for a sperm cell to mature, and a similar window applies to the preparation of an egg for ovulation in an IVF cycle. The lifestyle, stress levels and workplace environment an employee experiences today will directly shape their clinical outcome three months from now.
This has profound implications for how SMEs structure their support. A single day of compassionate leave around an egg retrieval, while welcome, is not the point. The biological lead-in — the three months in which keeping cortisol low matters most, is the period in which the employer’s culture is doing its real work, for good or ill. True support is a sustained environment, not a one-off concession.
For UK employers, particularly those running smaller businesses where HR is often a part-time concern, the temptation has long been to handle these matters informally and on a case-by-case basis. That approach is no longer fit for purpose.
Workplace support should not be viewed solely as a wellbeing initiative. It is a factor that can influence treatment tolerance, recovery and overall health outcomes — and, by extension, attendance, productivity and retention. Reproductive medicine specialists routinely see how a lack of flexibility and the strain of uncertainty add to the physical and emotional burden their patients are already carrying.
The modern framework, clinicians argue, should include protected time for medical appointments and treatment cycles; appropriate leave and recovery support following pregnancy loss at any stage; and trained managers capable of handling these conversations sensitively. Confidentiality, flexible working and access to emotional support should be considered core components of an occupational health approach, not optional extras.
Above all, the policy must remain adaptable. Fertility experiences are highly individual, and a rigid model, the kind British HR departments have historically loved, will not survive contact with the variety of clinical pathways now in play.
The businesses that grasp this will retain experienced women in their thirties, forties and fifties, the very demographic most likely to be promoted out of, and lost to, less enlightened employers. Those that don’t will continue to wonder why their best people quietly disappear. In 2026, that is no longer a wellbeing question. It is a competitive one.
Read more:
Why IVF and miscarriage still aren’t properly supported at work