Fertility treatment is expensive, and most people pay for at least part of it out of pocket. Three types of accounts can offset that cost: health savings accounts (HSAs), flexible spending accounts (FSAs), and lifestyle spending accounts (LSAs). HSA and FSA funds are pre-tax and governed by IRS rules under Section 213(d) and Publication 502. LSA funds are employer-defined and taxable, so they cover a different, often wider, set of expenses.
Below is what each account covers for IVF, ovulation tests and pregnancy tests specifically, where the rules are settled and where they're still contested, and how LSAs fill the gaps HSA and FSA funds can't reach.
Key takeaways
- IRS Publication 502 explicitly lists in vitro fertilization and pregnancy test kits as eligible HSA/FSA medical expenses, and explicitly excludes gestational surrogate costs.
- For 2026, the HSA contribution limit is $4,400 (self-only) / $8,750 (family), and the health FSA limit is $3,400 with a $680 carryover cap (Rev. Proc. 2025-19; Rev. Proc. 2025-32).
- 47% of large U.S. employers now cover IVF, and 70% of employers with 20,000+ employees do (Mercer, 2024 survey).
- LSAs sit outside IRS medical-expense rules entirely, which is why they can cover donor costs, surrogacy, adoption, and travel that HSAs and FSAs cannot (Compt).
Can you use FSA for fertility treatments?
Yes. IRS Publication 502 lists procedures "to overcome an inability to have children," including in vitro fertilization, as eligible medical expenses. FSA funds can go toward IVF, IUI, fertility medications, and related diagnostic testing once a plan administrator confirms the specific charge qualifies. For calendar year 2026, the health FSA contribution limit is $3,400, with a $680 carryover cap (IRS, Rev. Proc. 2025-32).
Not every fertility-related cost qualifies automatically. Extended embryo storage beyond an active treatment cycle and elective, non-medical egg freezing typically need a letter of medical necessity before an FSA administrator will reimburse them (CNY Fertility). Surrogate compensation and medical care are excluded regardless of medical necessity: the IRS states that "you can't include in medical expenses the amounts you pay for the identification, retention, compensation, and medical care of a gestational surrogate" (IRS, Publication 502).
Can you use HSA for IVF?
Yes. HSA funds can cover IVF procedures, including egg or sperm retrieval and temporary storage tied to an active cycle, under the same Publication 502 language that governs FSA eligibility.
That IRS standard doesn't say who qualifies to use it. Insurers and plan administrators have historically required a documented infertility diagnosis, often defined around a period of unsuccessful heterosexual intercourse, before treating IVF as reimbursable. That requirement has drawn active legal and legislative challenges. For example:
- Aetna reached a national settlement in December 2025 after a lawsuit argued its infertility diagnosis requirement excluded same-sex couples and single parents by choice from fertility coverage (CBS News).
- The Equal Access to Reproductive Care Act, reintroduced in Congress, would remove the medical-infertility requirement for tax purposes; it has not passed (Rep. Schiff's office).
- California's SB 729 takes a narrower, state-level approach, redefining infertility for large-group insurance plans effective January 1, 2026 to include the inability to reproduce without medical intervention, regardless of relationship status (Greenberg Traurig).
At the federal level, the Department of Labor, HHS, and Treasury confirmed in October 2025 that enrolling in fertility coverage structured as an excepted "specified disease or illness" policy does not disqualify someone from also contributing to an HSA (DOL, ACA FAQs Part 72). The same agencies proposed a rule in May 2026 that would create a separate excepted-benefit category for fertility care with a $120,000 lifetime cap per participant.
At the time of publication, that rule is still a proposal, with a comment period through July 13, 2026 and a target effective date of January 1, 2027 (Federal Register). It would sit alongside HSA and FSA accounts as a new benefit-design option, not change what Section 213(d) already allows inside them. A February 2025 executive order directing agencies to study IVF cost and access set some of this in motion, though it created no new coverage guarantee on its own (Washington Post).
Can you buy ovulation tests with HSA?
Generally, yes. Ovulation predictor kits are treated as HSA-eligible by plan administrators and retailers under the same general medical-care standard Publication 502 applies to other health-monitoring products, and the 2020 CARES Act removed the earlier requirement for a prescription on over-the-counter items (HSA Store). Unlike IVF or pregnancy tests, ovulation kits aren't named as their own line item in Publication 502, so confirm eligibility with your specific plan administrator before purchase.
Does HSA cover pregnancy tests?
Yes. IRS Publication 502 states this outright: "You can include in medical expenses the amount you pay to purchase a pregnancy test kit to determine if you are pregnant." Pregnancy test kits are named explicitly, with no administrator interpretation required.
Are ovulation tests FSA eligible?
Yes, under the same standard as HSA eligibility above. FSA and HSA eligibility lists are maintained by the same plan administrators and retailers, so ovulation predictor kits and monitors appear as eligible on both HSA Store's and FSA Store's eligibility lists. As with HSA funds, this reflects administrator practice rather than an explicit Publication 502 line item, so confirm with your FSA administrator if a purchase is declined.
How is an LSA different from an HSA or FSA for fertility care?
An LSA is fully funded by the employer and counts as taxable income to the employee, unlike HSA and FSA contributions. That taxable status is also what frees it from IRS Section 213(d) medical-necessity rules, so an employer can define eligible fertility expenses on its own terms, including donor egg or sperm costs, surrogacy compensation, adoption expenses, and travel for care, none of which HSA or FSA funds can reimburse (Compt).
For example, American Express reimburses employees up to $35,000 in adoption and surrogacy costs for up to two children through this kind of benefit (Compt). Carrot's own Carrot Card takes a similar approach: an employer-funded card that can cover eligible fertility and family-forming costs beyond what an HSA or FSA card allows, with built-in eligibility checks.
LSA adoption estimates vary widely by survey population. Compt's 2026 benchmark puts employer adoption at roughly 64–65%, while the International Foundation of Employee Benefit Plans found closer to 6% among corporate employers in 2024 (IFEBP).
2026 contribution limits at a glance
Where this fits into a fertility benefits strategy
HSA and FSA funds cover a real, IRS-defined slice of fertility spending: IVF procedures, medications, diagnostic testing, ovulation and pregnancy tests. But they stop at Section 213(d)'s medical-necessity line. Surrogacy, donor costs, adoption, and travel fall outside that line no matter how the underlying account is funded. An LSA is what closes that gap, and it's why more employers are pairing a standard HSA or FSA with an LSA rather than relying on either account alone.
Carrot helps employers design fertility, family-building and hormonal health benefits that work alongside whatever HSA, FSA or LSA accounts a company already offers, so employees aren't left guessing what's reimbursable. Talk to Carrot to see how a dedicated benefit compares with account-by-account coverage for your team.
