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President Barack Obama and former first lady Michelle Obama are famous for keeping the details of their personal life private.
But the Obamas have just gone public with a very intimate and painful struggle: They had a miscarriage and went on to use in vitro fertilization, or IVF, to conceive their two daughters 20 years ago.
In an early look at Michelle Obama’s new memoir, Becoming, the Associated Press reported that the Obamas turned to IVF after a miscarriage left them feeling alone, “failed,” and “broken.”
“We were trying to get pregnant and it wasn’t going well,” the former first lady writes. “We had one pregnancy test come back positive, which caused us both to forget every worry and swoon with joy, but a couple of weeks later I had a miscarriage, which left me physically uncomfortable and cratered any optimism we felt.”
By the time she hit her mid-30s, the former lawyer told ABC’s Good Morning America, she had a growing awareness that “the biological clock is real” and “egg production is limited.”
So she sought out IVF treatments from a fertility doctor and began giving herself hormone shots, the AP reported. While her “sweet, attentive husband” worked at the state legislature, she was left “largely on my own to manipulate my reproductive system into peak efficiency.” (For more about how the process works, read on.)
Eventually, Obama became pregnant, first with Malia, who is now 20, and then Sasha, now 17.
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Millions of Americans now turn to fertility clinics for help having babies, and about 2 percent of all US births involve some kind of assisted reproductive technology. Miscarriage is also the most common complication of pregnancy, with as many as one in five pregnancies resulting in one.
But people often don’t talk about these experiences, both because they can be physically and emotionally painful and because of the stigma and lack of awareness about how common they are.
That’s now rapidly changing. The Obamas’ revelation comes in the same week that actress Gabrielle Union and her husband Dwyane Wade shared that they had a baby with the help of a surrogate. Sen. Tammy Duckworth has also told her miscarriage and IVF story, along with Beyoncé, Chrissy Teigen, Khloe Kardashian, and other celebrities.
But Michelle Obama’s revelation may be particularly influential: With her book tour launching next week, she’s poised to help normalize miscarriage and become a powerful voice in a new generation of parents who are opening up about their struggles with infertility.
Since 1996, more than a million babies in the US have been born using IVF
A quick primer on fertility: In an unassisted pregnancy, a woman’s ovary releases an egg, and sperm finds and fertilizes the egg. That fertilized egg then travels through the fallopian tubes into the uterus, where it attaches and, if all progresses normally, grows into a fetus.
But this process can be thwarted for all kinds of reasons, not all of them well understood. A woman may not produce eggs every month, or her eggs may not be healthy. A man may not have enough viable sperm. Couples may be older, or have chronic diseases or sexual dysfunction that make conception difficult.
Enter assisted reproductive technology, or ART. It’s any fertility treatment that involves fertilizing an egg outside the body, and the most common type is IVF. With IVF, a woman’s ovaries are stimulated to produce eggs using medication, and then they’re removed from her ovaries. In liquid in a lab, a man’s sperm is combined with the eggs to produce a fertilized egg, which is then reinserted into the woman, where, if successful, it’ll result in a pregnancy.
As the Stanford scholar Hank Greely explained in Vox, “IVF is neither cheap nor fun.” It costs parents on average more than $12,000, isn’t always covered by insurance, and carries health risks. “Most of the cost, and all of the discomfort and risks, lies in harvesting eggs. Egg harvest requires weeks of injections with powerful hormones, the side effects of which lead to several hundred hospitalizations a year in the US.”
Still, more and more Americans are turning to assisted reproductive technologies to conceive.
“Four decades after the birth of Louise Brown, the first ‘test-tube baby’ conceived via in vitro fertilization (IVF), 33 percent of American adults report that they or someone they know has used some type of fertility treatment in order to try to have a baby,” a Pew Research Center survey reported this year.
Since 1996, more than a million babies have been born in the US using these technologies, including 75,000 babies in 2016 alone, according to Pew. Part of this is due to the fact that more couples, like the Obamas, are trying to get pregnant at older ages, when the odds of conception drop.
But as Obama hinted, some people still don’t feel comfortable discussing their infertility. In an interview with ABC, she revealed that she felt like she “failed because I didn’t know how common miscarriages were. ... We sit in our own pain, thinking that somehow we’re broken.”
Married African American women have higher rates of infertility than married white women, and may face even more intense stigma.
With Obama’s revelation, maybe that’ll change. As Obama put it, “That’s one of the reasons why I think it’s important to talk to young mothers about the fact that miscarriages happen.”
