Vice presidential candidate Minnesota Gov. Tim Walz celebrates with his daughter Hope, son Gus and wife Gwen at Democratic National Convention on Wednesday, Aug. 21, in Chicago. The Walzes clarified this week that they didn’t use IVF but another kind of fertility treatment to grow their family. (Justin Sullivan/Getty Images)

The broader scope of fertility treatments entered the spotlight this week after Minnesota Gov. Tim Walz and his wife Gwen shared that they had children through a less commonly known procedure.

Since Vice President Kamala Harris selected Gov. Walz as her running mate, he has discussed his family’s fertility journey during speeches in Pennsylvania, Nebraska and mostly recently at the Democratic National Convention in Chicago, Illinois.

“It took Gwen and I years,” Walz said on Wednesday night. “But we had access to fertility treatments. And when our daughter was born, we named her Hope.”

This week, the Walzes clarified that they conceived via intrauterine insemination, not in vitro fertilization.

IUI involves injecting sperm into the uterus during or just before ovulation to increase the chances of fertilization and pregnancy.

“Our fertility journey was an incredibly personal and difficult experience. Like so many who have experienced these challenges, we kept it largely to ourselves at the time — not even sharing the details with our wonderful and close family,” Gwen Walz said in a statement provided to States Newsroom. “The only person who knew in detail what we were going through was our next door neighbor. She was a nurse and helped me with the shots I needed as part of the IUI process.”

During IVF, eggs and sperm are combined in a lab and an embryo is inserted into the uterus. IVF has been drawn into national reproductive rights debates for much of this year, and Walz has been talking about it on the campaign trail while discussing his family’s fertility journey.

U.S. Ohio Sen. J.D. Vance, the Republican vice presidential candidate, accused his opponent of lying about how he and his wife had children. In an Aug. 20 social media post, Vance said, “Today it came out that Tim Walz had lied about having a family via IVF. Who lies about something like that?” He also shared a clip of Walz talking about fertility care and families on Aug. 9.

In a statement, Harris-Walz campaign spokesperson Mia Ehrenberg said, “Governor Walz talks how normal people talk. He was using commonly understood shorthand for fertility treatments.”

Experts said that patients commonly get IUI and IVF confused or refer to them interchangeably, given that in vitro fertilization is more popular.

“There’s such a huge sort of alphabet soup that comes along with assisted reproduction,” said Kimberly Mutcherson, a professor at Rutgers University-Camden who specializes in reproductive justice, bioethics, and family and health law.

Dr. Kelly Acharya, a fertility physician and assistant professor of obstetrics and gynecology at Duke University, said patients’ partners are more likely to mix up the two treatments or rope related procedures into IVF.

“A lot of times in my line of work, I see people that are referring to other things, like egg freezing, they call that IVF, even though technically it’s not,” she said.

Both Acharya and Mutcherson said the main differences between IUI and IVF are where fertilization occurs, the price and effectiveness.

“Intrauterine insemination or IUI is basically less invasive. It’s typically less expensive, and it is often what is recommended as the first thing that somebody tries,” Acharya said. “When somebody has mild forms of infertility, like if there are mild differences in the semen analysis, or if somebody is young and they’re not quite sure why they’re not getting pregnant, then often a provider will recommend that they do IUI as a first step to help things along.”

IUI is performed during or near ovulation, and it typically takes 10 minutes and is a minor procedure, according to Acharya. The price of IUI varies, depending on insurance coverage, from a few hundred dollars to several thousand dollars.

Mutcherson noted that some people also confuse IUI with intracervical insemination, or ICI. During this method, the sperm is inserted into the cervix — the passageway to the uterus, according to the Carolina Fertility Institute.

Doctors often recommend ICI or IUI as a precursor to IVF, which Mutcherson said can cost $12,000 to $15,000 per cycle — or more with grading and genetic testing. During IVF, “fertilization happens outside of the body,” Acharya said.

IUI, the treatment the Walz family used to have children, is not under the same scrutiny as IVF, which has faced opposition from anti-abortion hardliners. “It sometimes is listed as being less controversial than IVF, because it’s just helping along the natural process of getting the sperm inside the uterus and then expecting fertilization to happen inside the body,” Acharya said.

But Mutcherson said that could also be attributed to the fact that it’s a less well-known procedure.

“I think the really big issue when it comes to something like artificial insemination is that it allows people to create families that a lot of these folks — unfortunately, in the Republican Party and folks who are evangelicals — don’t approve of: families with two moms, families with two dads, single women who are having children,” she said.

Price is a significant barrier to fertility care. Only 21 states require insurers to cover fertility procedures, Stateline reported. A successful birth via IVF can cost more than $60,000, according to a 2022 study published in Reproductive Biology and Endocrinology.

“It requires a lot more physically, emotionally and economically to be able to do IVF,” Mutcherson, who conceived via IUI, said.

IVF became a national reproductive rights issue in February after the Alabama Supreme Court likened frozen embryos to “unborn children” in a ruling. The plaintiffs were couples who sued for damages under an 1872 wrongful death of children law after their embryos were accidentally destroyed in a clinic four years ago, Alabama Reflector reported. Alabama’s fertility clinics temporarily closed after the ruling until Republican Gov. Kay Ivey signed legislation in March shielding providers from criminal and civil liabilities, the Reflector reported.

But there’s still uncertainty over whether embryos and fetuses in the state have legal “personhood” rights. Despite the new law, two fertility clinics in Alabama announced plans to close by the end of the year, though one denied the decision was related to the? ruling.

Since the Alabama ruling, polls have shown most Americans back IVF. A survey conducted by Pew in April found that 70% said IVF is a good thing, while 22% said they’re not sure, and 8% said it’s a bad thing. Awareness is growing, too: 42% of Americans said they or someone they know have had fertility treatments, according to a 2023 Pew poll.

Nationally, Republicans and Democrats condemned the Alabama Supreme Court’s ruling and filed bills seeking to protect IVF this spring, though all of them stalled in Congress. The Republican Party’s platform featured support for both IVF and the equal protections clause of the 14th Amendment, which conservative legal scholars argue can be used to solidify “fetal personhood” along with effectively banning abortion. And in June, the Southern Baptist Convention — the largest Protestant denomination in the U.S. — voted to condemn IVF, particularly the destruction or donation of embryos that are not implanted in the uterus.

“People who believe that life begins at conception, people who believe that an embryo is no different than a 5-year-old sitting in a kindergarten classroom, those are people who have really deep and abiding principles related to procedures like in vitro fertilization,” Mutcherson said.

The number of babies born in the U.S. using assisted reproductive technology has increased in recent years: 2.5% of newborns were conceived using fertility treatments in 2022, according to the American Society of Reproductive Medicine. That’s up from 2.3% in 2021, per federal data.