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Michelle Obama shared something deeply personal in an interview Friday: She and Barack Obama struggled with infertility, had a miscarriage and used in vitro fertilization (IVF) to have their two daughters, Malia and Sasha.

“I think it’s the worst thing that we do to each other as women, not share the truth about our bodies and how they work, and how they don’t work,” Obama said on “Good Morning America,” in an interview promoting her forthcoming memoir.

What makes her story so remarkable is not that she and her husband had issues with fertility, but that she’s now talking about it and opening the door for the millions of women who had or currently have trouble conceiving to share their own stories.

The fact that the former first lady broached this subject could move the focus immediately to how public policy treats it. Obama’s new willingness to discuss her previously secret struggles can shine a new light on the prevalence of infertility and the incredible emotional and financial cost of going through medical treatments to have a baby.

Infertility is rarely discussed

Much like mental health is an invisible illness that people often fear speaking about, so is infertility. Last year, the American Medical Association voted to follow the lead of the World Health Organization and designated infertility a disease, hoping it would promote more insurance coverage of treatments and less stigma.

Richard Paulson, past president of the American Society for Reproductive Medicine, likened it to how people used to treat breast cancer.

“I remember an era when people didn’t talk about breast cancer and it was only when celebrities came forward and took it out of the closet and demystified it,” he said. “Infertility is a legitimate disease and there’s a cure for it and we have it.”

The worst-kept secret about infertility is just how common it is — as many as 1 in 8 couples have trouble getting pregnant or carrying a baby to term — but women still resist talking about it, often blaming themselves and silently carrying shame and anguish.

"Our culture is very hush-hush about reproduction and infertility in particular, it reaches to the very heart of our self-image, who we are and how we see ourselves. Many women still have that feeling that they are barren that they can’t perform this basic thing. And for men, it feels it reflects on their potency and masculinity,” Paulson said. “But it’s unbelievably common, and to have it out in the open is wonderful.”

Additionally, one in four pregnancies end in miscarriage — of the approximately 4 million pregnancies in the United States in a given year, that’s as many as 1 million women. And yet, because most miscarriages occur in the first trimester when women often don’t reveal their pregnancy, they go through the loss of that pregnancy in isolation.

Massive costs

While the Affordable Care Act, Barack Obama’s signature legislative achievement, mandated coverage of maternal health care, it did not require coverage of fertility treatments. Neither does Medicaid. And while 15 states have passed laws that insurers cover or offer coverage for infertility treatments, women in the remaining 35 states often must pay out of pocket if they hope to conceive. And even when it is covered, it’s sometimes only partially, and still requires a massive outlay of cash that is out of reach for most people.

IVF can cost as much as $20,000 a cycle, so the ability to have children becomes a question of means. In other words, only infertile couples with that kind of disposable income have full options when it comes to getting pregnant. It’s perhaps the starkest example of health access disparities.

In May, Sen. Cory Booker (D-N.J.) and Rep. Rosa L. DeLauro (D-Conn.) introduced legislation requiring insurers to cover infertility treatments without raising premiums or co-pays. The bill never went anywhere, but could find new life in a Democratic-led House with a record number of female members.

Speaking out, decreasing stigma

Infertility rates continue to rise as more and more women wait until later in life to start families. The Obamas were in their mid-30s when they went underwent IVF.

“I felt lost and alone and I felt like I failed, because I didn’t know how common miscarriages were, because we don’t talk about them,” she said.

“We sit in our own pain, thinking that somehow we’re broken.”

Obama isn’t the first political figure to discuss openly her infertility. Earlier this year, Sen. Tammy Duckworth (D-Ill.) announced she was pregnant with her second child, making her the first sitting senator to have a baby.

Discussing her pregnancy, Duckworth shared, “I’ve had multiple IVF cycles and a miscarriage trying to conceive again, so we’re very grateful."

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