When people think about fertility benefits, they typically focus on the headline offerings FSA-Eligible: IVF coverage, maybe surrogacy support if they’re lucky, and that’s about it. But fertility journeys rarely follow straightforward paths, and the financial burden extends far beyond the most visible procedures. There’s an entire ecosystem of fertility-related expenses that most people don’t realize they can pay for with pre-tax dollars through their Flexible Spending Accounts—potentially saving 30-40% through tax advantages.
The challenge is that FSA eligibility for fertility expenses exists in a frustratingly gray area. The IRS says medical expenses must be for “diagnosis, cure, mitigation, treatment, or prevention of disease” to qualify. But fertility isn’t always clearly a disease in the traditional sense, which creates confusion about what is and isn’t eligible. Different FSA administrators interpret guidelines differently, and many people simply assume their fertility expenses won’t qualify and never bother investigating.
This assumption costs people real money. Between federal and state income taxes plus FICA taxes, using FSA-Eligible funds instead of post-tax dollars can save you roughly 30-40% on eligible expenses. On a $10,000 fertility treatment, that’s $3,000-4,000 in tax savings that many people leave on the table simply because they don’t understand what qualifies.
Making this more complicated is that eligibility often depends on medical necessity determination. If you’re pursuing fertility treatments because of a diagnosed medical condition—like endometriosis, PCOS, low sperm count, or any other fertility-related diagnosis—you’re on much stronger ground for FSA eligibility than if you’re pursuing fertility preservation for non-medical reasons. The distinction matters, and documentation from your healthcare provider is critical.
The FSA Vendor Variable
Not all FSA programs interpret eligibility the same way, which adds another layer of complexity. Some FSA vendors take a conservative approach, requiring extensive documentation and medical necessity letters for anything beyond basic IVF. Others are more accommodating, accepting a broader range of fertility-related expenses with minimal documentation.
When reviewing your benefits, understanding your specific FSA vendor’s policies around fertility expenses is worth a direct conversation. Don’t rely on general IFS guidelines—ask explicitly: “What documentation do you require for egg freezing expenses? How about genetic testing? What about supplements prescribed by my fertility doctor?” The answers can vary significantly depending on which administrator your employer uses.
Some progressive FSA administrators have developed specific fertility expense categories and streamlined approval processes recognizing that these are legitimate medical expenses for many people. Others still treat fertility expenses as special cases requiring additional scrutiny. Knowing where your vendor falls on this spectrum helps you plan appropriately.
Egg Freezing: The Documentation-Dependent Expense
Egg freezing (oocyte cryopreservation) is FSA-eligible, but with important caveats. If you’re freezing eggs because of a medical condition that threatens your fertility—cancer treatment, endometriosis, impending surgery that might affect fertility—the expenses are generally clearly eligible. You’ll need documentation from your doctor explaining the medical necessity, but approval is typically straightforward.
Elective egg freezing for non-medical reasons (often called “social egg freezing”) is more complicated. Some FSA administrators won’t approve these expenses at all, viewing them as elective rather than medically necessary. Others will approve them if your doctor provides a letter documenting fertility concerns that make egg freezing medically advisable even without a specific diagnosis.
The expenses involved in egg freezing are substantial: initial consultation and testing ($1,000-2,000), medications for ovarian stimulation ($3,000-5,000), the retrieval procedure ($6,000-10,000), and annual storage fees ($500-1,000). If even portions of these costs qualify for FSA coverage, the tax savings are significant.
Strategy tip: If you’re planning egg freezing, schedule it for early in the year after you’ve elected your FSA contribution amount. This ensures you’ve allocated sufficient funds. Also, get the medical necessity documentation from your doctor before submitting any claims—it’s much easier to get this upfront than retroactively.
Genetic Testing: Usually Eligible with Documentation
Fertility-related genetic testing is typically FSA-eligible when recommended by your doctor as part of fertility treatment or family planning. This includes:
Carrier screening: Testing prospective parents for genetic conditions they might pass to children is generally eligible when recommended by a healthcare provider, especially if you have family history of genetic conditions or belong to ethnic groups with higher prevalence of certain genetic diseases.
Preimplantation genetic testing (PGT): If you’re doing IVF, genetic testing of embryos to screen for chromosomal abnormalities (PGT-A) or specific genetic conditions (PGT-M) is typically FSA-eligible. These tests cost $3,000-7,000 per IVF cycle, so FSA coverage provides meaningful savings.
Male fertility genetic testing: Karyotype testing, Y-chromosome microdeletion analysis, and other genetic tests for male factor infertility are generally eligible when ordered by your physician.
The key across all genetic testing is having a healthcare provider order the test for medical reasons. Direct-to-consumer genetic testing “just because you’re curious” likely won’t qualify, but the same test ordered by your doctor as part of fertility evaluation or family planning typically will.
Intrauterine Insemination (IUI): Fully Eligible
IUI is generally fully FSA-eligible as a medical fertility treatment. This includes the procedure itself ($500-1,500 per cycle), ovulation induction medications if used ($100-500), and monitoring ultrasounds and bloodwork ($200-500).
Many people don’t realize that IUI attempts—which are substantially less expensive than IVF—qualify for FSA funding. If you’re trying multiple IUI cycles before moving to more aggressive treatments, maximizing your FSA contribution to cover these expenses makes financial sense.
Fertility Medications: Broadly Eligible
Prescription medications for fertility treatment are FSA-eligible, including ovulation induction drugs (Clomid, Letrozole), injectable hormones for IVF (gonadotropins), progesterone supplements for pregnancy support, and other prescribed fertility medications.
The costs here can be substantial—injectable medications for IVF stimulation alone can run $3,000-7,000 per cycle. Using FSA funds for these prescriptions is straightforward; your pharmacy can typically process FSA payment directly.
Over-the-counter supplements are trickier. Prenatal vitamins aren’t FSA-eligible unless prescribed by your doctor (a prescription changes the classification). The same applies to supplements like CoQ10, DHEA, or other fertility supplements—get a prescription from your fertility doctor, and they’re more likely to be approved.
Fertility Preservation for Medical Reasons: Strong Eligibility
If you’re facing medical treatment that threatens your fertility—chemotherapy, radiation, gender-affirming surgery, or other procedures—fertility preservation is clearly medically necessary and FSA-eligible. This includes:
Sperm banking before cancer treatment or vasectomy ($500-1,500 initial cost plus storage fees)
Egg or embryo freezing before cancer treatment or other fertility-threatening procedures (costs detailed above)
Ovarian tissue cryopreservation in cases where egg retrieval isn’t feasible ($8,000-15,000)
For these situations, document the medical necessity clearly. Your oncologist’s letter stating that chemotherapy will likely affect fertility and recommending preservation creates strong support for FSA eligibility across all related expenses.
Donor Expenses: It Depends
Expenses related to using donor eggs, sperm, or embryos have mixed FSA eligibility:
Donor sperm purchased for fertility treatment is typically FSA-eligible ($500-1,000 per vial). This is considered part of fertility treatment costs.
Donor egg expenses are more complicated. The eggs themselves and the retrieval procedure costs might be eligible as part of your fertility treatment, but compensation paid to the donor might not be. Legal fees definitely aren’t eligible. Documentation and FSA administrator interpretation matter significantly here.
Storage fees for donated genetic material used in your treatment are generally eligible as part of ongoing fertility treatment costs.
Acupuncture and Alternative Treatments
Acupuncture for fertility is FSA-eligible when performed by a licensed practitioner, whether it’s specifically for fertility enhancement or general wellness. Many fertility clinics now recommend complementary acupuncture, and costs ($75-150 per session) can add up across multiple treatment cycles.
Other alternative treatments are harder to get approved. Massage therapy, even when recommended for stress management during fertility treatment, typically isn’t eligible unless prescribed for a specific medical condition. Yoga classes, meditation apps, and similar wellness expenses generally don’t qualify even if they support fertility treatment.
Counseling and Mental Health Support
Mental health counseling related to fertility treatment is FSA-eligible. If you’re seeing a therapist to help cope with the emotional aspects of fertility struggles, those sessions qualify. This includes both individual and couples counseling.
Many fertility clinics require or strongly recommend psychological evaluation before proceeding with IVF or using donor gametes. These evaluations are clearly eligible ($200-500 per evaluation).
Surrogacy: Partial Eligibility
If you’re using a gestational surrogate, the medical expenses are typically FSA-eligible, but non-medical expenses aren’t:
Eligible: IVF procedures, embryo transfer, prenatal care, delivery costs (though usually covered by the surrogate’s insurance)
Not eligible: Surrogate compensation, agency fees, legal fees, surrogate’s non-medical expenses
The eligible medical expenses can still be substantial, so it’s worth tracking carefully and using FSA funds for qualified portions even though much of surrogacy costs won’t qualify.
Documentation Best Practices
To maximize FSA approval for fertility expenses:
Get a letter of medical necessity from your fertility doctor for any expenses that might be questioned. The letter should explain your diagnosis, why the treatment is medically necessary, and how the expense relates to your treatment.
Keep detailed records of all expenses, organized by category. Your FSA administrator might request documentation months after treatment.
Submit claims promptly with clear descriptions. “Fertility treatment – IVF cycle” is better than just “medical expense.”
If denied, appeal with additional documentation. Many initially denied claims are approved on appeal with proper medical necessity documentation.
Plan Your FSA Contribution Strategically
Fertility treatment costs are unpredictable. You might have one successful IVF cycle, or you might need three. You might add genetic testing halfway through. But understanding what’s potentially eligible helps you estimate more accurately.
If you’re planning to pursue fertility treatment during the upcoming plan year, consider contributing the FSA maximum ($3,200 for 2024) if you can afford it. Even if you don’t use all funds for fertility expenses, you’ll likely have other eligible medical expenses to use remaining balances.
The tax savings on fertility treatment are too significant to ignore. These expenses are already financially and emotionally overwhelming—at least minimize the tax burden by understanding and leveraging every available pre-tax benefit opportunity.
