New York City councilwoman Melinda Katz began a career in public service when she was 28, but by the time she was 40 and wanted to have a baby, she learned she was infertile.
Today, at 42, neither medical technology nor being single stands in the way of Katz having that baby — only her insurance company.
Katz, who championed women's health issues while serving in the New York State Assembly, discovered she was not entitled to insurance coverage for in vitro fertilization (IVF) that might have given her a baby.
"Having a baby is an important part of life," said Katz, who told ABCNews.com she saved her money and paid for the IVF herself. It took three failed tries, but the petite city counselor is now expecting a boy, with a donor egg and sperm, in June.
"The state doesn't cover a lot of fertility treatment and it should," said Katz, who, as a Democrat, wrote the law requiring HMOs to provide women direct access to gynecological care without forcing them to first see a primary care physician.
"It's a very expensive process and I was lucky enough to pull together tens of thousands of dollars," she said. "Many women don't have that great fortune."
Like Katz, an estimated 2 percent of all American woman experience fertility problems, but only some of them can afford the expensive advances in technology that make pregnancy possible.
Katz, who hails from the well-heeled neighborhood of Forest Hills, Queens, can afford that luxury. As a single woman, she earns $125,000 a year and is running for the city comptroller job, which pays an annual salary of $185,000.
Still, the financial burden is only a part of the pain of IVF. "It's a very emotional process, and by the end, I knew I really wanted this child, it was so long and arduous."
Only 15 states mandate fertility care, and many, like New York, do not cover IVF, egg donation or other pricier procedures.
"I worked so long, it should be available to most women," Katz said. "We have very good insurance in New York City — one of the best in the country."
States vary widely in their mandates, and so individual insurance carriers are called on to fill the gap.
In New Jersey, IVF is allowed, but not for women older than 46. Hawaii limits women to one try, but in Massachusetts, there are no limits in the number of treatment cycles. In Arkansas, payments are capped at $15,000.
But, those so-called mandates are deceiving, according to Resolve, the National Infertility Association, which advocates equal access to medical care for fertility issues or reproductive disorders. Massachusetts, for example, has the oldest and strongest mandate, but large companies with self-insured plans and small employers are exempt.
"In some states, it's not even a full mandate, and in some there is really no coverage at all," said Barbara Collura, executive director of Resolve. "It's a relatively large number of people who do not have access to care. As high as 50 percent of those diagnosed with infertility would benefit from medical intervention and are not getting the care that they need."
Of the approximately 62 million women of reproductive age in 2002, about 1.2 million, or 2 percent, had an infertility-related medical appointment within the previous year, and 10 percent had an infertility-related medical visit at some point in the past, according to the Centers for Disease Control.