Introduction Infertility is increasingly recognized as a public health and social issue with implications for employment and workplace policy. In Japan, the use of assisted reproductive technology (ART) has increased alongside rising female labor force participation. Consequently, balancing infertility treatment and employment has become an important social issue. Okinawa Prefecture, historically one of the highest fertility regions in Japan and undergoing demographic transitions, provides a unique setting to examine infertility treatment and employment. This setting may be relevant to regions with increasing female labor force participation and delayed childbearing. This study aimed to clarify employment-related impacts, workplace disclosure, and employer support in Okinawa Prefecture, Japan. Methods A regional cross-sectional web-based survey was conducted between March 16 and July 31, 2023. Individuals undergoing infertility treatment were recruited through facilities, and companies with 10–1,200 employees were also surveyed. The study followed the STROBE statement. Descriptive statistics summarized employment impact, workplace disclosure, and organizational support. Results A total of 163 individuals and 38 companies responded. Among women, 25.6% experienced employment-related impacts and 10.9% resigned during treatment. Partial or no workplace disclosure was reported by 71.2%, while adverse workplace experiences were reported by 11.7%. Among companies, 84.2% had not implemented support measures. Conclusions Workplace disclosure remains limited and is a key challenge in balancing infertility treatment and employment. Organizational and policy-level interventions—particularly improved workplace communication and greater awareness of available support systems—may support work–treatment balance. Further longitudinal and multi-regional research is warranted.