When Nichola Johnson-Marshall was undergoing IVF, she grew accustomed to walking around Canary Wharf, her handbag full of needles, on the lookout for an available loo so she could inject the hormones that might help her conceive a second child.
“[I would] balance needles and medication dosages on the toilet while I was trying to measure out the quantities that I needed that day,” recalls the 43-year-old, who worked in financial communications. As the only female director at her company, she says she didn’t feel able to tell colleagues that she was having IVF.
More than 69,000 cycles of IVF are completed in the UK every year, according to the latest data available – and many women will choose not to tell their boss.
Seetal Savla, 38, from London, says that she was apprehensive about telling a previous employer – a luxury concierge company – partly because she didn’t know how her boss would react, but also, she explains, because of perceived stigma about seeking help to conceive, which she suggests can be more pronounced in Indian families.
″[There was] the general embarrassment and guilt of having to admit to someone, especially someone in the workplace who you don’t know very well, that you’re struggling to conceive,” she says. “It makes you feel like a failure in front of your superiors.”
But when she did tell her manager, she was supportive and excited about Seetal’s decision. “She was always checking in with me discreetly to see how things were going, and I felt comfortable discussing the details with her,” she says.
When interviewing for a new job, however, Seetal recalls one potential employer mentioning a blog about IVF she’d posted on her website. “While the interviewer was very complimentary about the piece, I did wonder whether that discussion, and the fact that I’d been so open about wanting to start a family, played any part in their decision not to offer me the job,” she says.
Emma, 39, from Rochester, works in social media marketing and had two cycles of IVF. Knowing that the treatment might not work was a factor in her decision not to tell her employer. “I didn’t want to be treated any differently in the fear it may not work and didn’t want anyone to know,” says Emma, who chose not to share her surname.
“I had to use holiday for appointments and made sure I was home in time to inject. It was hard to manage the emotional side of it and act as normal while living with the fact that you are trying to create your dream.”
Seetal’s first cycle of IVF, through the NHS, had a “less intrusive” appointment and injection schedule than the one she is currently navigating at a private clinic. Under the NHS, she could complete all her injections at home, but her new, personalised plan requires her to carry her medication in a small cold bag and measure out doses during the day.
Nichola also had to juggle a tough routine. “I had to have daily blood tests very first thing in the morning. I would go before work at about six o’clock in the morning, be at my desk before nine as if nothing had happened, then during the day I would get a phone call about the specific dosage of drugs that I would have to inject,” she explains, adding that she’d often feel nauseous from the medication.
“Sometimes, depending on what part of the procedure it was, I would then have to get to the clinic quickly for a follow up blood test.”
One of the worst days at work was when she received a phone call to say her cycle had been unsuccessful, but had to carry on as if nothing had happened.
After moving to a different job where she had female managers, Nichola decided to tell her new employer she was having IVF. “They were very empathetic, so I do think that made a very big difference,” she says. “It took the pressure off – so I could say I needed a day off because I was having the egg transfer and I wasn’t pretending to be off sick.”
While Katherine Cotterell, 38 from London, experienced practical challenges with IVF, it was the emotional impact of IVF she found most difficult. Katherine has had four cycles of IVF – three rounds at a previous job and one while working in her current position. At both workplaces, she only told her employers when things eventually became too much.
“By far the biggest challenge for me was trying to have enough headspace and emotional capacity for both my job and treatment, which I at times found almost impossible and hugely overwhelming,” she says.
“I felt like I was failing at my job because I couldn’t 100% mentally commit to it and I felt like I wasn’t giving myself the best chance for the IVF to work because I was so stressed out all the time.”
Seetal says “extreme fatigue and hormonal fluctuations” were a big problem for her during previous IVF cycles. “The smallest things used to have me in floods of tears. During my last cycle, I also felt a lot of resentment, guilt and jealousy every day – an emotional cocktail which made it very hard to handle clients in a rational way,” she says. “Work can be a welcome distraction for some, but it was a hindrance for me.”
When Seetal was made redundant at the start of her current cycle, she decided not to hunt for another job. Having time to rest has made a huge difference, she says.
But Emma found being freelance during her third cycle brought new challenges. “My previous job was very stressful and in a way was a great distraction,” she says. ”[Being] freelance made it easier logistically, but meant I had no one around me to take my mind off it.”
Taking a career break or going freelance, however, often isn’t an option. Nichola would like policy-makers to create a law around fertility leave, enabling women to take time off for treatment via their HR departments, without fear of repercussions.
For this to happen, we need to raise awareness of and be more open about the impact of IVF and other treatments, she says. “I think to normalise it, we need to acknowledge that men go through it as well, maybe not to the extreme, but they might have wives or partners that are going through this too,” she says.
Although not everyone feels able to speak to their employer about IVF, for Seetal, Nichola and Katherine, this experience of eventually doing so was positive.
Katherine’s first employer worked closely with her to make sure juggling the demands of treatment and work were manageable, allowing her to work remotely when she needed. “They were also very flexible around clinic appointment times which they understood often happened without much notice and were difficult to plan around,” she says.
Her current employer has been equally understanding, particularly when her mental health began to suffer during the fourth round of IVF. “They gave me the option to take two months off for the final stage of it which was really the best thing I could have done,” she says. “Even though that cycle also failed, I felt much stronger and able to cope as I had the time off to deal with both the failure of the last cycle and the ones before.”
This article originally appeared on HuffPost.