You can use an FSA for fertility treatments when the care addresses a diagnosed inability to have children. That covers IVF, fertility medications, diagnostic testing, and surgeries to reverse a prior sterilization, along with related travel. It does not cover surrogacy costs, elective egg freezing, or an egg donor’s medical expenses. For 2026, the health care FSA contribution cap is $3,400, which softens the cost of treatment without paying for a full cycle.
The Rule That Decides Eligibility
FSA eligibility comes from Section 213(d) of the Internal Revenue Code, which defines medical care as amounts paid to diagnose, treat, or prevent disease or to affect a structure or function of the body.1Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses IRS Publication 502 applies that definition to fertility by allowing the cost of procedures performed “to overcome an inability to have children.”2Internal Revenue Service. Publication 502, Medical and Dental Expenses
That phrasing is doing real work. The care must respond to infertility as a medical condition, not simply help a fertile person build a family through another route. The federal employee FSA program spells the distinction out, listing “infertility treatment” as eligible while categorizing general “fertility treatment” as ineligible.3FSAFEDS. Eligible Health Care FSA (HC FSA) Expenses Private administrators generally reach the same conclusions because they are working from the same IRS rules.
What Your FSA Will Pay For
IVF is the largest expense that fits cleanly inside the rule. Egg retrieval, embryo creation, and embryo transfer all qualify. Publication 502 also allows surgery to reverse a prior sterilization procedure, so vasectomy reversals and tubal ligation reversals count.2Internal Revenue Service. Publication 502, Medical and Dental Expenses Other corrective surgeries, like clearing blocked fallopian tubes, qualify under the same reasoning.
Supporting costs during a treatment cycle are eligible as well:
- Prescription fertility medications used to stimulate ovulation, regulate hormones, or prepare the uterine lining.
- Diagnostic testing including ultrasounds, hormone bloodwork, semen analysis, and hysterosalpingograms.
- Short-term storage of eggs, sperm, or embryos tied to an active treatment cycle. Publication 502 uses the phrase “temporary storage” without a fixed cutoff; most administrators treat storage beyond 12 months as ineligible.
- Over-the-counter ovulation predictor kits, fertility monitors, and pregnancy tests.
- Preimplantation genetic testing of embryos when it screens for medical conditions.
Travel and Lodging
Getting to a clinic counts. The 2026 standard mileage rate for medical travel is 20.5 cents per mile, and parking and tolls are eligible on top of that.4IRS.gov. 2026 Standard Mileage Rates If treatment requires an overnight stay, lodging is eligible up to $50 per night per person, so a patient traveling with a spouse can claim up to $100 per night.2Internal Revenue Service. Publication 502, Medical and Dental Expenses Meals during medical travel are not eligible.
What Your FSA Won’t Pay For
Some of the largest costs in modern family-building sit outside the rule, and the gaps catch people off guard.
Surrogacy
Publication 502 states that you cannot include amounts paid for the identification, compensation, or medical care of a gestational surrogate.2Internal Revenue Service. Publication 502, Medical and Dental Expenses The IRS treats a surrogate as an unrelated party, so her medical expenses are not your medical care even when your own infertility diagnosis is what led to the arrangement. Legal fees for surrogacy contracts fall outside the rule entirely because they are not medical costs.
Elective Egg Freezing
Freezing eggs to guard against age-related fertility decline is not eligible. The IRS does not treat natural aging as a disease, so preservation without a medical trigger fails the necessity test. Egg freezing does become eligible when a physician recommends it before chemotherapy, radiation, ovarian surgery, or treatment for conditions such as severe endometriosis or premature ovarian insufficiency. A Letter of Medical Necessity from the treating physician, identifying the diagnosis and explaining the recommendation, is what supports the claim.
Donor Eggs and Sperm
Costs tied to an egg donor’s medical care, including retrieval and compensation, are generally not eligible under Section 213 because the IRS considers them payment for the medical care of someone who is not your spouse or dependent.1Office of the Law Revision Counsel. 26 USC 213 – Medical, Dental, Etc., Expenses Your own procedures in a donor-egg cycle, including embryo transfer and monitoring, still qualify. The line follows whose body the care is directed at.
Long-Term Storage and Gender Selection
Storing eggs, sperm, or embryos indefinitely for possible future use crosses from active treatment into elective preservation, and most administrators deny storage claims beyond one year from the initial procedure. Procedures performed only for gender selection, without a medical indication like screening for sex-linked genetic disorders, also fall outside the definition of medical care.
2026 Contribution Limits and Timing
The 2026 health care FSA contribution maximum is $3,400. If your employer offers the carryover option, up to $680 of unused funds can roll into the next plan year.5FSAFEDS. New 2026 Maximum Limit Updates Some plans offer a grace period of up to two and a half months after the plan year ends instead, but a plan cannot offer both.6HealthCare.gov. Using a Flexible Spending Account (FSA) Anything left beyond those limits is forfeited.
A single IVF cycle typically runs $12,000 to $20,000 once medications, monitoring, and the procedure are added up, so a $3,400 election will not cover the whole bill. It will lower your taxable income by that amount, which is worth roughly $850 to $1,200 in federal tax at typical brackets, plus state income tax and FICA savings. If you and a spouse each have access to a separate employer FSA, both of you can contribute the full amount, putting $6,800 in pre-tax dollars toward treatment in one year.
Timing your election matters. Diagnostic work, medications, and monitoring usually start weeks before retrieval and transfer, so a cycle that crosses a plan-year boundary lets you fund it with two elections. On the other hand, if your treatment will finish within a few months, be careful not to over-elect: anything above the carryover ceiling disappears at year end.
When an HSA Fits Better
If you are enrolled in a qualifying high-deductible health plan, a Health Savings Account may be a stronger option. HSA-eligible expenses follow the same Section 213(d) rules, so anything eligible for an FSA is eligible for an HSA. The differences are the limits and the rollover. For 2026, HSA contributions are capped at $4,400 for self-only coverage and $8,750 for family coverage.7Internal Revenue Service. IRS Notice 2026-05 HSA Limits HSA balances roll over indefinitely, so a balance built over several years can absorb a much larger share of treatment costs than a single-year FSA. You generally cannot contribute to both a standard health care FSA and an HSA in the same year.
Documentation and Denied Claims
A Letter of Medical Necessity is not required for every fertility claim. Standard infertility care, including IVF, prescription fertility drugs, and diagnostic bloodwork, usually just needs an itemized receipt or Explanation of Benefits showing the date of service, provider name and address, description of the service, and amount charged.8Internal Revenue Service. IRS: Eligible Employees Can Use Tax-Free Dollars for Medical Expenses
The letter matters when a claim sits on the boundary between medical and personal, or when the same procedure could serve either purpose. Egg freezing before cancer treatment is the clearest example: without documentation from an oncologist or reproductive endocrinologist explaining the diagnosis and the recommendation, the administrator cannot tell the claim apart from an elective one. Keep a digital copy, since some administrators require a new letter each year.
Fertility claims are denied more often than routine medical claims, and the reason is usually missing documentation rather than actual ineligibility. Before starting a formal appeal, check whether a Letter of Medical Necessity, a more detailed receipt, or a diagnosis code would resolve the problem. Resubmitting with the right paperwork is faster than working through the appeal levels most plans use. If a formal appeal does become necessary, watch the filing windows in your plan documents; they tend to be shorter than people expect.