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.

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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.”