On Friday, Michelle Obama, whose autobiography Becoming is set to hit bookshelves Tuesday, November 13, revealed that she suffered a miscarriage before giving birth daughters Malia and Sasha - both of who were conceived via IVF.

Sadly, the former First Lady isn’t alone with her fertility struggles. According to the Department of Health, one in six couples experience fertility problems. While these statistics might not be surprising, Obama’s struggles, which occurred in her early 30s, sheds light on the fact that infertility impacts women of all ages and that women in their late 30s and early 40s aren’t the only ones undergoing the expensive fertility treatments.

“We were trying to get pregnant and it wasn’t going well,” Obama, 54, wrote in her upcoming memoir, previewed by the AP. “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.”

She discussed the emotional impact of her infertility during an appearance on Friday’s Good Morning America. “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.”

In her memoir she explains that she and Barrack decided to undergo IVF. She self-administered her fertility shots alone, to help speed up the process as her “sweet, attentive husband” was at the state legislature, “leaving me largely on my own to manipulate my reproductive system into peak efficiency.”

What is IVF?

In brief, IVF is a process through which multiple eggs are produced in a woman's monthly reproductive cycle through the use of injection medications which stimulate the ovaries, says Reproductive Endocrinologist Dr Nina Resetkova. Once the eggs are harvested through a surgery called an egg retrieval, they are combined with sperm in the laboratory to create embryos. The viable embryos are then cultured in a laboratory incubator and transferred back into the uterus to create the potential of pregnancy within the same reproductive cycle. "The process of harvesting numerous eggs and creating embryos helps to overcome the related decline in embryo quality, allowing for the selection of the best embryos with the highest potential to create pregnancy," she explains.

While IVF was definitely available two decades ago, it has become more popular in recent years, as it is more readily available (with more insurance companies covering it) and also more effective, according to Dr Resetkova, due to new technologies and laboratory standardisation.

Do women of all ages get IVF?

According to Dr Resetkov, the average age of a women undergoing IVF at her clinic is 37-38-but it's a myth that younger women never need IVF. But she points out that they do see patients for reproductive health services ranging from their teenage years through the menopause and in some cases beyond. Since Mrs Obama was likely in her early 30s when she started IVF treatments, she would be considered on the younger side.

"We recommend women under 35 seek evaluation after 1 year of trying for pregnancy and women over 35 after 6 months of trying for pregnancy, in order to capture the best likelihood of IVF success, which is age related," she explains.

What causes of infertility in women?

Dr Resetkova explains that various factors can contribute to the inability to conceive and carry a baby to full term, even for younger women. These include patients with irregular menses due to causes like polycystic ovary syndrome (PCOS), fallopian tube disease, complex medical problems or have a history of many abdominal surgeries.

More recently, IVF has also been used to help couples who are at risk for a child with a genetic disease, such as Tay Sachs, adds edocrinologist Dr Zev Williams. It can also be helpful for those who are carriers of genes that could result in the child being at increased risk for cancer (such as BRCA), so they can have healthy children and not pass on cancer genes.

There can also be a problem when it comes to the sperm as well. "Male factor infertility, which occurs when a male partner in a heterosexual couple has low sperm count, typically requires IVF treatment and those patients tend present at a younger age," explains Dr Resetkova. Then, there are LGBT patients who also make up the population of those getting IVF at a younger age.

But, in general, younger women have the best chances of success with IVF. "The best prognosis group is under 35 years of age," she adds. Why? Dr Williams explains that as a woman ages, her eggs are more likely to have chromosomal problems that prevents a healthy pregnancy from occurring.

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