Provision and policy across the force areas currently differ widely, with many forces having no established policy in this area. This guidance is therefore designed to provide consistency and best practice.
It is also designed to complement other policies, such as:
Sickness and absence (these will need to be reviewed to ensure they do not discriminate against those undergoing fertility treatment, particularly in the advanced stages of treatment or where a pregnancy results).
Equal opportunities and harassment (forces should review these policies to ensure they cover discrimination and harassment claims that could arise in connection with fertility treatment and could also consider inserting relevant wording into equal opportunities and harassment policies). Sex discrimination and maternity discrimination provisions may apply in relation to a woman undergoing IVF treatment, depending on the stage of the treatment.
Fertility treatment is a growth area – with an estimated increase in treatments of 5-10% each year - therefore it is essential that forces consider and cater for staff undergoing such treatment. A bespoke policy is recommended as the individual nature of every treatment means existing policies around ‘elective surgery’ (for example) would be inappropriate. Provision throughout private industry and other public services has also been examined – some offer funding for egg freezing, others offer paid leave, and many have yet to act.
The key to effective policy in this area is flexibility. Fortunately, policing is an area which tends to lend itself to flexibility – shift patterns can be adapted, shifts adjusted, roles and responsibilities varied. Taking the time to get a good fertility policy in place will help retain staff and officers within the service – and particularly help to reduce attrition.
This is a fast moving and developing area – with treatment, procedures and practice changing rapidly. Policies require regular review and update in response to these changes.
Fertility treatment is different for every individual; it can range from drug treatments through to a full assisted in-vitro fertilisation (‘IVF’) process. Even within the IVF process there is a wide variety of treatment which will be different for each person. Some patients undergo many cycles of IVF and many people who undergo IVF do not become pregnant. Fertility problems are estimated to affect one in six or one in seven couples in the UK - approximately 3.5 million people. This figure doesn’t cover same sex couples or single people. In many cases infertility is unexplained. Live birth rates after IVF are estimated to be around a third now compared to around a quarter in 2010 according to UK figures from the Human Fertilisation and Embryology Authority (‘HFEA’). IVF birth rates have increased for patients under 43 years. About 54,000 patients had 68,724 fresh and frozen in-vitro fertilisation (IVF) cycles and 5,651 donor insemination (DI) cycles at HFEA licensed fertility clinics in the UK in 2018. Many people choose to go abroad as NHS funding offers differ from area to area. The cost of a single round of IVF is approximately £5000 or more at a private clinic in the UK.
Two of the most common fertility treatments are Intrauterine Insemination (‘IUI’) and IVF. Provided below are details of some of the various fertility options and some of the common side effects.
IUI involves preparing semen in a laboratory to select only the highest quality sperm for insemination. The treated semen is introduced into the womb just before ovulation and can be used with either natural ovulation or in conjunction with clomid or injectables such as follicle stimulating hormone to induce ovulation in which case regular scans are required to monitor the progress of follicles which produce eggs. IUI side effects might include:
IVF means ‘in glass’, which is where the term ‘test tube baby’ originates. However, no test tubes are actually involved in the process. It seems deceptively simple to mix sperm and eggs together until the eggs are fertilised, but it requires closely controlled laboratory conditions and skilled embryologists to maintain. IVF requires the female to harvest eggs using stimulating hormones to create a higher number of eggs than would usually be produced in a standard female cycle. Regular scans are required to monitor the progress of follicles, which produce the eggs. Eggs are then collected from the female via a surgical procedure under anaesthetic. A sperm sample is then collected from a male partner or donor. Once the eggs are fertilised, the embryos are carefully incubated, and the best are selected for transfer into the womb a few days later. The remaining embryos can be frozen for future use if required (see below – FET). Please note that not all eggs collected will fertilise successfully or result in an embryo suitable for implantation.
Some IVF medications have to be taken/injected at the same time each day and can cause general discomfort such as pain in the ovaries and feeling bloated. Specific IVF medication/treatment can also make everyday issues such as travel to work and/or having to wear uniform very uncomfortable and/or difficult. Treatment may involve weeks of medication in preparation for egg collection and months of medication following implantation of an embryo. Some medication can also cause headaches, fatigue, dehydration, and excessive urinating (impacted by the need to drink plenty of water). Overall, side effects can include:
*OHSS can occur after egg collection and can include quick weight gain, abdominal pains, nausea and or vomiting, blood clotting in the legs, decreased urination, shortness of breath and tight or an enlarged abdomen. Symptoms can lead to hospitalization and/or an extended recovery period.
FETs use a cryopreserved embryo(s) which is transferred into the uterus. The whole process is a lot simpler than its preceding IVF specific steps such as self-injection and retrieval of eggs is not required. Instead, hormones will be taken to build the uterine lining in preparation for receiving the embryos, which also produce side effects such as those experienced in an IVF cycle. Medication is also frequently required post implantation for many weeks or months.
Ovulation induction is recommended for those who haven’t yet reached menopause but aren’t ovulating at all or infrequently. This process involves a minimal drug regimen (if absolutely necessary) and the use of ultrasound to see whether there is a follicle maturing. Results from the ultrasound inform whether natural ovulation, tablets or a series of injections are used.
This approach does not require further medical intervention and is often the first option when treating infertility due to polycystic ovary syndrome or other conditions which inhibit ovulation.
During standard IVF treatment, the eggs and sperm are mixed in a petri dish and fertilisation occurs spontaneously. When the sperm are not active enough/ insufficient or there are issues with fertilisation ICSI allows a single sperm to be manually injected into an egg thereby increasing the chances of successful fertilisation. The other parts of the IVF cycle, the controlled ovarian stimulation and embryo transfer, are the same as in the standard process outlined above.
Many people cannot use their own eggs or sperm to produce a child, or they don’t have a partner who can provide the missing gamete (egg or sperm). Strictly governed modern medical practices use donor eggs, sperm or embryos.
Fertility treatment and infertility more generally, has long been and continues to be a taboo topic, more so in some cultures than others. Whilst attitudes are slowly changing, it must be stressed that the personal nature of the treatment involved and associated risks, mean that line managers should keep discussions highly confidential. Furthermore, information relating to an individual’s treatment will fall into the special categories of personal data under GDPR and should therefore be handled in accordance with this and the force’s data protection policies.
Fertility treatment can be a specific part of gender reassignment treatment and can involve treatment to preserve fertility.
In researching this guidance, the amount of time off given by forces for IVF treatment was found to differ considerably. Some forces offer 40 hours per year, others five days per cycle for up to three cycles per year and other forces offer unlimited, but reasonable paid special leave. Focus groups and consultations found that where leave offered was insufficient, IVF patients would be forced to take sick leave or annual leave to complete their treatment.
The use of sick leave can create additional stress because of the negativity associated with taking periods of sickness. Currently most force policies would not consider pre-embryo transfer sickness as pregnancy related – and could thus impact applications for lateral and upward progression. Line managers should talk through time off required after medical treatment, particularly with reference to the more invasive treatment. However, if an individual is ill owing to the treatment and not fit to work, either through physical or psychological side-effects, then forces must treat this as sickness absence and deal with an individual’s entitlement to sick pay in accordance with the normal rules. Sickness should not be treated as special leave.
Forces should distinguish between time off for medical appointments and time off for treatment. Time off for medical appointments will likely be covered in existing force policy. Any policy which offers such latitude should be accompanied by an explanation of the processes and what that means for those involved.
Forces are entitled to request/ require the individual concerned to produce a statement/letter from a medical practitioner, detailing the type of treatment recommended and being undertaken, prior to granting time off.
How much time is required?
Due to the varying nature of IVF treatments available and the individual application of each treatment, similar treatments can differ for the same person between cycles. The fair application of a ‘one size fits all’ approach is therefore impossible. Some forces were found to provide unlimited but reasonable compassionate leave yet specify limited leave for fertility treatment. The amount of time off required also depends on role and whether the individual is full or part time – shift work and frontline, physical work may require more adjustment and flexibility. It may also be possible to vary shifts to allow appointments to take place.
There are some appointments which require anaesthetic (egg retrieval) where the patient will not be permitted or able to drive themselves. There are also pivotal points in the process where it is recommended that the patient would be accompanied.
The psychological impact of IVF treatment should not be under-estimated. Multiple rounds can take their toll financially, physically, and psychologically. As a minimum, recipients of IVF would need to attend the following appointments, and these can be at short notice:
Eleven to thirteen days after embryo transfer the patient conducts a pregnancy test. If successful IVF patients have a viability scan two to three weeks after a positive test to confirm a heartbeat (at approximately six to seven weeks of pregnancy). These stages can be extremely difficult if the pregnancy test is negative or if the pregnancy fails; miscarriage policies would apply in either case. If the implantation is successful and the pregnancy continues, protection from discrimination on the ground of pregnancy/ maternity exist until the end of maternity leave or return to work if that is earlier. If the implantation is unsuccessful, the protected period lasts two weeks following implantation.
A successful viability scan would see the patient referred back into the regular NHS pregnancy monitoring process with the same access to ante-natal appointments and scans as other patients. Due to the complex nature of fertility, some patients require close monitoring and continue taking hormone medication for twelve weeks of pregnancy or beyond or other medication for the duration of their pregnancy.
It is recommended that forces consider allowing individuals to apply for a temporary change to their working pattern whilst undergoing fertility treatment, as opposed to a permanent change through a flexible working request. This would be in addition to permitted time off, e.g. a temporary change to a working pattern to cover an IVF cycle. Examples of flexible working options, including home working, which forces might consider for those undergoing fertility treatment could be referenced within forces’ flexible working policies.
Some people will decide to seek treatment abroad – often this move is financially motivated, as it can be significantly cheaper. Some clinics will offer some of the treatment and checkup appointments in the UK with just the final stages of the treatment abroad.
Rules regulating the number of embryos that can be transferred at once can differ abroad – this can increase the chance of becoming pregnant with multiples. Risks associated with multiples (twins, triplets etc.) are much higher, therefore in the UK there are strict regulations in relation to the number of embryos that may be transferred.
Choosing to use clinics abroad will add significantly to the time staff will need to take away from the workplace. In these circumstances it will be necessary for staff to take a mixture of annual leave and unpaid leave. Given that this will also mean that the individual will be unable to perform their duties flexibly (as with UK treatment) it would be appropriate to offer a reasonable and specified period of paid special leave of 40 hours per cycle. Forces may find it helpful to specify that this would be offered on a pro-rata basis for those performing a part-time role.
Support for a person going through fertility treatment is crucial. Some partners (of all genders) may be physically involved in the fertility process; however, all partners will provide a key role in supporting the person receiving fertility treatment.
Due to the timed precision of IVF, scans and procedure dates are booked by the clinic at short notice for specific dates and times and therefore it is very difficult to rearrange appointments particularly when in a treatment cycle.
Types of appointments/procedures:
Circumstances where partners will be physically involved and required to attend for treatment: Male partners:
Reciprocal IVF allows partners to be involved in the IVF process. In the process of reciprocal IVF, one partner donates their embryo (created using donor sperm) to the other who will carry the pregnancy. The donating partner will need to take fertility medications to help them produce a number of mature eggs that will then be collected in an egg retrieval procedure (as outlined above). These eggs will then be inseminated with the selected donor sperm with the aim of creating an embryo. The pregnancy carrying partner will have tests and undergo preparations so that their womb is ready for the implantation of an embryo. The embryo will then be transferred to the receiving partner’s womb for implantation.
This process is sharing the fertility treatment therefore reasonable special leave (depending on the individual circumstances) should be offered for when each person is undertaking their part of the process.
Some people will undergo a number of treatment cycles per year and the length of treatment may vary depending on the type of fertility treatment.
The recommendation is therefore that a partner is allowed 10 hours of special leave per treatment cycle. A treatment cycle is defined as starting from a consultation appointment through to a positive/ negative pregnancy test at the end of the treatment. The partner can allocate their special leave to their appointments/procedures of choice. Forces may specify that this be pro-rata for those who are part time.
Preimplantation Genetic Diagnosis (PGD) is a technique that enables couples/individuals with a particular inherited condition in their family to avoid passing it on to their children.
The process helps potential parents prevent the birth of a child with a serious genetic condition.
This is not a decision that is taken lightly by those choosing to undergo the process, and usually involves having to decide between attempting to conceive in a conventional way versus months/years of treatment in an attempt to secure the health of any potential children. The procedure for PGD is similar to that of in vitro fertilisation (IVF), with an extra step to check whether embryos are affected by a serious genetic condition. There are, however, additional considerations for those families undergoing PGD and Force policies should allow for assessment on a case-by-case basis.
The most frequently diagnosed diseases and disorders that can be diagnosed through PGD are:
The above conditions bring with them their own emotional considerations and using BRAC1 as an example, this diagnosis is often brought about when a family member develops breast cancer and is subsequently tested for the gene. This leads to familial testing and diagnosis and influences decisions to undergo PGD treatment.
In some cases, the PGD appointments will bring about significant emotional responses and the welfare of those involved must be considered. This is equally as important when offering organisational support to partners who may be under additional pressures providing support during the process.
It is worth noting that PGD is only offered at regional genetic centres and therefore travel times may be significantly more than for a standard IVF process, with those undergoing treatment having to travel many miles for appointments.
During fertility treatment, an individual will need support and to know that they can confidentially discuss their concerns and/or requirements with their line manager. Once the individual notifies their line manager/force that they are about to start / are undergoing fertility treatment, a suitable risk assessment form will need to be completed. The risk assessment should contain the following considerations and mitigation, and should be treated as a living document – reviewed regularly as the considerations will change throughout the IVF treatment cycle.
The force has a duty of care to individuals during this potentially stressful time. Undergoing a fertility programme can be a very traumatic experience both physically and emotionally and the role of a line manager is to provide relevant and sufficient support as required. Risk assessment is a changing and ongoing process throughout treatment and pregnancy.
Surrogacy is legal in the UK; however, a surrogacy agreement cannot be enforced in UK law. The surrogate remains the child’s legal birth parent at birth until a transfer is made and a parental order or adoption is completed.
There are a number of ways of conducting surrogacy, however what is common is the need for the involvement of the prospective adopter(s) from the outset.
It may be that the prospective adopters go through IVF in order to achieve a successful pregnancy in a surrogate – in which case appropriate leave must be given in line with these recommendations.
Surrogacy is becoming more common, and the chapters relating to fertility and adoption are both relevant to this practice. In addition, where the prospective adopters wish to attend the medical appointments of the surrogate – even where they have no physical involvement, these requests should be accommodated. Where a surrogate gives birth, they are entitled to full maternity leave, regardless of whether or not they are caring for the baby at any point during that time.
Worldwide fertility rates have halved since the 1950s, in part due to social factors. Some estimate as many as one in six couples are infertile and fertility treatment demand rises between five and ten percent each year. As the need for fertility treatment grows, and with the desire to increase the proportion of female officers and staff across policing – the need for consistency and leadership in parenting policy as a whole is critical. The difficulty with implementing policy in this space is the need for flexibility, and a recognition of the individual nature of each person and each treatment. It is therefore imperative that senior oversight of the application of policy across a force area is clear and present. This short-term investment to support people of child-bearing age is essential in order to maintain an experienced female workforce in policing. Best practice includes:
For more information, check out the resources below: