Michelle Harris spends her days taking care of sick people as a registered nurse in a Honolulu hospital.

She sees the amazing improvements in her patients who receive the latest treatments to help extend their lives. She witnesses how medications can help those with chronic conditions like heart failure, kidney failure, dialysis and cancer, and knows that their care is covered by their medical insurance, no matter how often they need to come back.

So when Harris, 37, and her husband learned that they were dealing with infertility, she expected that any treatments for this would be covered by their medical insurance as well. She knew other couples who had seen specialists and had conceived children, and hoped that she would soon be able to as well.

That’s when she learned the harsh truth. Since 1987, insurance companies in Hawaii have been required to cover infertility treatment, but only once for a cycle of in vitro fertilization. Given the rates of success that vary with age, Harris’ chances are about 20 to 30 percent. She and her husband know that it often takes more than one round of treatments to have a child.

This meant that if her first session didn’t work, it would cost up to $30,000 each time they tried again.

Harris started wondering why insurance companies cover multiple treatments for other chronic conditions but not infertility.

Bypass is covered for those who have heart disease, in addition to cholesterol medication and blood pressure medication. Diabetes is treated for life, even if the recommended dietary changes aren’t made.

“No one tells a kidney patient they only have one year of dialysis,” Harris says.

Only 14 states mandate coverage for some type of infertility treatment. Hawaii is one of those, but only for the one cycle of in vitro fertilization.

There are additional eligibility restrictions, such as requiring that the condition has been present for at least five years, and only allowing the use of a spouses’s sperm to fertilize eggs, not any other donor. This,  in turn, eliminates coverage for same-sex couples. In addition, only certified medical clinics on an approved list can provide the services if insurance coverage is provided.

Any further treatments are at the direct expense of the patients. For Harris and her husband, that may mean using their retirement savings to cover the cost of having a child. The other options include taking a loan to pay for the services. Some infertility clinics in Hawaii have website links to companies that are involved in borrowing money for the treatments.

Even the Affordable Care Act, which added coverage for many reproductive services, doesn’t have infertility treatment listed as an essential health benefit. Although insurance coverage can’t be denied for this pre-existing condition, there is no mandate to provide universal coverage, either.

Should medical insurance cover all fertility treatments until a child is conceived?

Harris and her husband believe the answer is a resounding yes.

Not everyone agrees, including the insurance companies.

Couples can purposefully get separate insurance coverage so that they can utilize the benefit under each other’s plan and cover two cycles. But even then, it doesn’t double their chances.

Other surgical procedures that have less chance of success than in vitro fertilization have no limitations. For women, blocked fallopian tubes can be a cause of infertility, and surgery to correct this costs $8,000-$13,000 and is covered by insurance. Procedures for men are also covered with no restrictions.

Harris is willing to pay if that is what it takes, she’s just hoping that she will be able to have a child before it comes to that.