The former US first lady, in an interview promoting her forthcoming memoir, shared a painful and personal secret. Picture: AP

Washington - In a week that saw tremendous gains for women in public office, Michelle Obama just broke another major barrier.

The former US first lady, in an interview promoting her forthcoming memoir, shared a painful and personal secret: She and Barack Obama struggled with infertility, had a miscarriage and used in vitro fertilization (IVF) to have their two daughters, Malia and Sasha.

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.

"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 in an interview on Good Morning America.

That this particular woman 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.

While the Affordable Care Act, her husband's signature legislative achievement, mandated coverage of maternal healthcare, it did not require coverage of fertility treatments. 

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.

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 Organisation and designated infertility a disease, hoping it would promote more insurance coverage of treatments and less stigma.

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.

It's a sad reality that Obama spoke to directly.

"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, Senator Tammy Duckworth 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."