Paying for Medical Treatments

PAMELA MADSEN SURVEYS HER TINY BRONX APARTMENT, rolls her eyes in resignation and dubs the place her "shrine to infertility." On the one hand, it's a temple to love. On the other, it's a reliquary for ceded dreams.

Pamela and her husband, Kai, their two kids, cat, a bird, and some fish live in an apartment about the size of a two-car garage. It's so small, Pamela laughs, that you can stride from the foyer, through the den, past the aviary, across the living room, and into the dining area in half a dozen steps. Then you come to a door, which leads into what was a snug little breakfast nook.

"In my more romantic moments, I call it the pleasure cove," Pamela laughs.

Wedged into the space is the parents' bed and dresser. Without straining much, Pamela could reach over from the bed to crank up coffee on the stove. "I've never done that," she deadpans, "but it brings a whole new meaning to breakfast in bed."

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Pamela Madsen works in her home office.

The Madsens' two boys, ages 10 and 6, sleep in bunk beds in the real bedroom. The children were both born by in vitro fertilization (IVF), after a long and costly struggle against infertility that included numerous tests and procedures. The quest for Tyler and Spencer swallowed up $30,000 or more, all the money that might have gone to buying a house.

"It set us back a lot," Kai says. "We ran up a bunch of credit-card debts. We paid for what we could in cash and charged everything else."

The couple married in 1981, setting out with typical newlywed dreams. Pamela says, "They had to do with two kids, a collie, a picket fence, and a station wagon. And we aspired and worked for that. Well, we've got the two kids and each other."

This, Pamela points out repeatedly, is a blessing of riches. But the Madsens also felt betrayed because their insurance plans covered almost none of the infertility procedures. She is a public school teacher; he works in the computer industry. While their plans would pay to repair a weekend football injury or for a vasectomy, IVF is not covered. "I think it's discrimination," Pamela says flatly. Affluent people can pay out-of-pocket and just tone down their lifestyle a bit.

"Are we saying that if you're a sanitation worker, or a cop, or a school teacher, that you don't deserve to have kids because you can't afford it?" Pamela says.