Mike Pence and Karen Whitaker’s courtship was a whirlwind. Nine months after they started dating, the future vice president hollowed out two loaves of bread to hold a small bottle of champagne and a ring box, and presented them to his girlfriend while they were feeding ducks at an Indiana canal. The couple will celebrate their 32nd wedding anniversary in June. But their marriage has not been all champagne and hollowed-out loaves of bread. The second lady has alluded previously to her difficulty getting pregnant, telling an Indiana reporter in 2013 that after years of trying she thought she might never conceive. This week, in an interview with the conservative website The Federalist, the mother of three spoke in more detail about her six-year experience with infertility.

The new interview, which is pegged to National Infertility Awareness Week, is as soft and fuzzy as a baby blanket. But it is revealing nonetheless. Pence talks about her anxiety about trying to get pregnant in her mid-30s, the heartbreak of having to answer insensitive questions about why she didn’t have children yet, and how her struggle challenged her understanding of her faith. “How could God put this desire in my heart and not bring me kids?” she said. “I’ve got to tell you, it made me question Him a lot.” Most intriguing, Pence refers to undergoing a fertility treatment at some point. “When you go through a procedure, and you spend $10,000 and it doesn’t work, it’s really frustrating,” she tells interviewer Melissa Langsam Braunstein. “It’s really, really frustrating.”

The “procedure” Pence refers to certainly sounds like in vitro fertilization. IVF is the most common form of assisted reproductive technology, and the $10,000 price tag aligns roughly with the cost of an IVF cycle. But Melissa Langsam Braunstein, who conducted the interview, told me in an email that Pence actually used a rare alternative to IVF called Gamete Intra-Fallopian Transfer, or GIFT. The two procedures have similar ends, but there’s at least one key difference: GIFT is accepted by the Catholic church, while IVF is not. (A representative for Karen Pence did not provide comment by press time.)

Karen Pence doesn’t say in the Federalist interview when she underwent the procedure, or whether it was successful. The couples’ three children were born in 1992, 1994, and 1995, a period when the Pences seem to have been shifting away from Catholicism and toward evangelical Protestantism. In a 1994 interview with the Indianapolis Business Journal, Pence referred to himself as “evangelical Catholic,” but by the next year, as the Washington Post reports, he was attending an evangelical Protestant megachurch. Before the mid-1990s, however, the Pences had a long history in mainstream Catholicism. Before he met his wife, Mike Pence had applied to graduate school with the goal of becoming a priest. The couple first met at their Catholic parish, when Mike approached Karen after seeing her playing guitar in Mass. And they were married in the Catholic church.

With that in mind, it’s not surprising that the Pences would have avoided using IVF as they struggled with infertility. The Vatican’s doctrine committee forbade IVF in 1987, issuing a document called Donum Vitae (“The Gift of Life”) that declared certain fertility treatments to be immoral because they do not require intercourse—“neither in fact achieved nor positively willed as the expression and fruit of a specific act of the conjugal union.”

But Donum Vitae does not decree that the concept of assisted reproductive technology is sinful in itself. The key guideline is that technology that “assists” marital intercourse is moral, and technology that “substitutes” for intercourse is immoral. For those concerned with that distinction, GIFT has several key advantages over IVF. The sperm and egg are brought together outside the woman’s body, as in IVF, but they are separated by an air bubble within a test tube. The contents of the tube are then surgically injected into the woman’s fallopian tube, with the hope that fertilization will occur there. In some cases, the man wears a perforated condom to collect the sperm sample during intercourse, which provides the dual benefit of avoiding sinful masturbation and keeping open the possibility that any resulting pregnancy resulted “naturally” from an escaped sperm. Technically, GIFT remains “under discussion” by the Vatican, but that gives devout couples wide leeway to make their own decisions. Some providers promote it as the only ART acceptable to the church.

What does Karen Pence’s use of GIFT mean? For one, it suggests she and her husband bent over backwards to obey the tenets of their faith, even as they spent years yearning to become parents. “I didn’t care about fame or fortune, big house, fancy career, nice car—none of that has ever been important to me,” Pence tells Braunstein. “I just wanted to be a mom.” It would take several speculative leaps to connect the Pences’ religious evolution to their experience with infertility happening at the same time. But it’s worth noting that Protestantism is much more fluid when it comes to fertility treatments. Within some pro-life Protestant circles, IVF remains controversial because it typically produces embryos that are later destroyed. But there is no moral or theological objection within Protestantism to the procedure itself.

But the real reason the Pences’ private decision matters is what it says about the vice president’s very public approach to reproductive politics. Technology means it is now almost impossible to separate the issues of abortion, contraception, and ART. As a pro-life congressman, Mike Pence co-sponsored “personhood” legislation that was primarily aimed at criminalizing abortion, but could have effectively prohibited IVF along the way. The version Pence co-sponsored in Congress defined eggs at “the moment of fertilization” as human beings with “the right to life guaranteed by the Constitution.” IVF experts fear that kind of language would make it illegal to produce the number of embryos the procedure requires to be most effective. (Personhood bills remain popular with Republican legislators even as they have failed over and over to become law.) The Pences’ use of GIFT suggests they have thought seriously about their own moral approach to the seconds and minutes surrounding conception. If only Mike Pence would empathize as deeply with the millions of women faced with private reproductive dilemmas of their own.