Yes, HSA funds can be used to pay for most fertility treatments. The IRS classifies fertility procedures as qualified medical expenses when they are performed to overcome an inability to have children. That includes major treatments like IVF and IUI, fertility medications, diagnostic testing, and even surgical reversals of prior sterilization. There are some important exceptions and limits, though, especially around storage fees, surrogacy, and elective egg freezing.
What the IRS Considers Eligible
IRS Publication 502 spells out the core rule: you can use pre-tax medical funds, including your HSA, for procedures that help you, your spouse, or your dependent overcome an inability to have children. The key phrase is “overcome an inability.” This means the expenses need to be tied to a diagnosed fertility issue or an active effort to conceive, not simply preserved as an option for someday.
Eligible expenses fall into a few broad categories: procedures like in vitro fertilization and the temporary storage of eggs or sperm, surgery to reverse a vasectomy or tubal ligation, fertility medications, and the diagnostic workups that come before any of those treatments.
IVF, IUI, and Related Procedures
The full IVF process is HSA-eligible, covering each step from ovulation induction through egg retrieval, fertilization, and embryo transfer. That also includes the medications prescribed to stimulate egg production, the blood tests used to monitor hormone levels, and vaginal ultrasounds to track follicle development. IUI (intrauterine insemination), which is a less invasive and less expensive procedure, qualifies the same way.
Donor egg extraction is also reimbursable when it’s part of treating your infertility. Sperm washing, infertility monitors, and egg donor costs can all qualify. If you’re going through multiple IVF cycles, each round is eligible as long as it’s tied to overcoming infertility.
Fertility Medications
Prescription fertility drugs are HSA-eligible. These typically include hormonal medications that stimulate ovulation or help the body become more receptive to pregnancy. Whether you’re taking oral medications early in treatment or injectable hormones as part of an IVF cycle, both count as qualified medical expenses. Over-the-counter fertility supplements, on the other hand, generally don’t qualify unless they’re prescribed by a doctor for a specific medical condition.
Egg, Sperm, and Embryo Storage
Storage is where the rules get tighter. The IRS allows temporary storage of eggs, sperm, or embryos as part of an active fertility treatment plan, but “temporary” has a practical ceiling. Storage fees typically can’t exceed 12 months to remain eligible for reimbursement. You’ll also need a Letter of Medical Necessity from your doctor confirming that storage is part of a medically necessary reproduction plan.
Elective egg freezing for potential future use is not eligible. If you’re freezing eggs at 30 because you might want children later, that won’t qualify. The distinction comes down to whether the storage serves an immediate medical need versus a precautionary one. Long-term storage beyond 12 months is also not reimbursable, even if the original reason was medically necessary.
Surgical Reversals
If you previously had a vasectomy or tubal ligation and now want to conceive, the reversal surgery is an HSA-eligible expense. The IRS explicitly includes operations to reverse prior surgery that prevented someone from having children. This applies whether the procedure is performed on you or your spouse.
Surrogacy: The Major Exception
Surrogacy is the biggest area where HSA coverage breaks down. The IRS specifically excludes most surrogacy expenses. If a surrogate mother is not your tax dependent, the medical costs she incurs are not reimbursable from your HSA. Since surrogates are almost never the intended parent’s tax dependent, this effectively rules out paying for a surrogate’s medical care with HSA funds.
There is a narrow exception: if the surrogate happens to be a qualified dependent of yours (a rare situation), certain costs like blood compatibility testing and psychological exams could be reimbursable. For the vast majority of people using surrogacy, though, those expenses will come from after-tax dollars.
Diagnostic Testing and Initial Workups
The appointments and tests that happen before you even begin treatment are also eligible. Fertility diagnostics, including semen analysis, hormone panels, ultrasounds, and other tests used to identify what’s making conception difficult, all qualify as HSA expenses. This is true whether the testing leads to a treatment plan or simply confirms a diagnosis. If you’re just starting the process of figuring out why you’re having trouble conceiving, you can use your HSA from day one.
HSA Contribution Limits for 2025
Fertility treatment costs can add up quickly. A single IVF cycle often runs $15,000 to $20,000 or more, which far exceeds what you can contribute to an HSA in a single year. For 2025, the maximum contribution is $4,300 for individual coverage and $8,550 for family coverage. If you’re 55 or older, you can add an extra $1,000 in catch-up contributions.
Because of this gap, many people build up their HSA balance over several years before starting treatment, or they combine HSA funds with other payment methods. HSA balances roll over year to year with no expiration, so saving in advance is a practical strategy. Any investment growth inside the account is also tax-free when used for qualified medical expenses, which makes an HSA one of the most tax-efficient ways to pay for fertility care.
Documentation to Keep
Your HSA administrator may not ask for receipts upfront, but you should keep thorough records in case of an IRS audit. Save itemized bills, explanation-of-benefits statements, and pharmacy receipts for all fertility-related expenses. For egg or embryo storage specifically, you’ll need a Letter of Medical Necessity from your doctor that explains why storage is part of your treatment plan and confirms it’s for short-term, medically necessary use. Without that letter, storage fees can be denied on review even if they would otherwise qualify.