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My husband and I had been trying to conceive for three years at that point; we were patients at a reproductive endocrinology clinic in North Carolina, where we lived, but like Margaret and her husband had limited insurance coverage and burdensome student loans, and we thought we’d never be able to afford IVF.

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It’s easy to see, even in many states that have attempted to provide infertility coverage, who gets left out: People who have complicated diagnoses or need expensive treatment, like Margaret; people who are older; LGBT couples; people in unmarried partnerships; or women who have decided to get pregnant on their own.

“I have friends who live elsewhere who don’t have this level of insurance and don’t make enough money to pay for the treatments,” Margaret told me.

Massachusetts is by far the best state in which Margaret could have landed.

Virtually everyone in Massachusetts has health care — the coverage level today is at 99 percent, the highest in the nation.

These treatments are so much less effective than IVF that most clinics don’t even keep careful track of them; doctors seem to be guessing when they offer success rates. The problem for people like Margaret is that coverage is mandated only for “the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.” That means that a woman with a correctable tubal blockage or a man with a varicocele affecting sperm production could have surgery to address those issues, even though surgery might not be the most effective or fastest treatment, and even though those issues are less common, for example, than diminished ovarian reserve or poor sperm count.

IVF — often the most effective treatment, and the one most people have trouble affording — is specifically excluded from New York’s mandate.

Margaret is a writer and middle-school teacher; she loves running and the outdoors, and looks to my eyes a decade younger than her age of 45.

We met in 2011, at a summer conference for writers, talked books and stories, gossiped, drank wine, went swimming; but the greatest sorrow of both of our lives — that we could not have children without expensive medical treatment — never once came up, not until a year later, when I began publishing essays about my experience with infertility and assisted reproduction.

Our doctor considered IVF a better, and certainly faster, course of treatment given our diagnosis and history, but we balked at the price — around ,000 for a single cycle, not including medication — especially as we knew it was possible we’d need multiple rounds of treatment.

I was lucky: Richard and I eventually saved enough to pay for what’s known as a shared-risk package, and conceived our daughter through IVF.

“It’s heartbreaking to me because it seems that having children should not be based on being wealthy enough.” In the Resolve support group I attended for more than two years, we rarely talked about money or the cost of treatment.

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