Costs

While egg freezing has grown in popularity — with a 46% increase in egg freezing cycles from 2020 to 2021 alone! — it has also increased in cost. As a result, one question that often arises is whether existing healthcare financial structures, such as Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs), can be used to cover these expenses. In this article, we delve into the complex and nuanced world of HSAs and FSAs, particularly as they relate to egg freezing.

How HSAs and FSAs work

An HSA is a tax-advantaged medical savings account available to individuals enrolled in a High-Deductible Health Plan (HDHP). An FSA, on the other hand, is an employer-sponsored benefit that allows employees to contribute pre-tax dollars to pay for eligible healthcare expenses.

A key characteristic of HSAs and FSAs is their ability to be used for “qualified medical expenses,” which are broadly defined by the Internal Revenue Service (IRS). These expenses include costs associated with  diagnosis, cure, mitigation, treatment, or prevention of disease, as well as  treatments affecting any part or function of the body. Importantly, the funds  can be used for expenses that are not covered by your health insurance plan, including deductibles, co-payments, and other non-covered expenses.

Is egg freezing a qualified medical expense?

The issue arises when we attempt to categorize egg freezing under these “qualified medical expenses.” As of the writing of the article, the IRS does not specifically list egg freezing as an eligible expense. However, they also do not explicitly exclude it. 

In their guidance, the IRS states that the primary purpose of the expense must be to alleviate or prevent a physical or mental defect or illness. Therefore, if egg freezing is done for a medical reason, such as preserving fertility before undergoing chemotherapy, it may be possible to argue that it falls under “qualified medical expenses.” But when the procedure is carried out for non-medical reasons, such as lifestyle or career choices, it’s a gray area.

The IRS list is not all-inclusive, and medical eligibility is often subject to interpretation and specific circumstances. So if you’re hoping to use an HSA or FSA for egg freezing, you will definitely want to consult with a tax professional or an accountant to gain a comprehensive understanding of your unique situation.

All of the expenses associated with egg freezing, and if they qualify

Egg freezing encompasses a range of expenses, each contributing to the overall cost. We break them down here as it’s possible that some - even if not all - may qualify in the eyes of the IRS. 

Initial consultation

This usually involves an appointment with a fertility doctor to assess your health, discuss the egg freezing process, and possibly begin preliminary testing. As this is a medical consultation, it may fall under "qualified medical expenses" if it’s related to a specific medical condition or concern.

Birth control

Birth control may be prescribed for the weeks leading up to your cycle to give your care team more control over the timing of your egg freezing procedure, help your ovaries better respond to fertility drugs, and minimize the growth of cysts. Prescription birth control generally counts as an eligible medical expense unless otherwise restricted by your employer's plan documents.   

Ovarian stimulation medications 

Prior to the egg retrieval procedure, you are given hormonal medications to stimulate the ovaries to produce multiple eggs. The IRS states that you can include the amount you paid for “prescribed medicines and drugs,” thus these medications may qualify.

Monitoring and lab work

During the egg freezing cycle, you will have multiple visits to monitor your hormones and follicle development. The categorization of the lab work and monitoring may depend on the specific medical circumstances surrounding the egg freezing cycle.

Egg retrieval procedure 

The egg retrieval procedure often involves the use of sedation or anesthesia. The retrieval and the associated anesthesia may be categorized as a medical expense, but it’s again contingent upon the specific circumstances.

Egg storage

The process of actually freezing the eggs and then storing them at sub-zero temperatures requires a significant amount of resources and technology. As of the current regulations, this is the expense that is least likely to be categorized as a “qualified medical expense.” The primary reason being that the IRS stipulates that healthcare storage (like cord blood banking) is only considered a qualified expense if it's reasonable to believe the stored material will be used to treat a pre-existing or imminent medical condition. 

If you qualify for our Split program, where you can freeze your eggs for free when you donate half to another family who can’t conceive (think: LGBTQ+ parents, those with infertility, and more), your cycle coverage includes up to 10 years of frozen egg storage! 

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Future thawing, fertilization, and embryo transfer 

These procedures occur if and when you decide to use your frozen eggs to attempt pregnancy. They involve further medical procedures and medications, which, under most circumstances, can be considered "qualified medical expenses."

Travel and transportation

Depending on the proximity of the clinic, travel and transportation costs may be a significant part of the overall expenses. However, the IRS typically does not include travel costs for non-emergency medical procedures as qualified expenses. Each case might be different, so consultation with a tax professional is advisable.

Supplements 

In some cases, women may be advised to take certain dietary supplements during the process to boost their overall health or egg quality. The IRS includes supplements as a qualified medical expense if they are used as “treatment for a specific medical condition diagnosed by a physician” A Letter of Medical Necessity (LMN) could potentially justify their use as part of a broader treatment plan.

Despite the potential categorization of several of these procedures as qualified expenses, it's important to note that the overarching reason for the egg freezing process may influence whether these expenses are considered “qualified” by the IRS. This interpretation varies widely, so consultation with a tax professional or legal advisor is strongly recommended to understand your individual situation.

Getting a Letter of Medical Necessity (LMN)

A Letter of Medical Necessity (LMN) plays a critical role when seeking reimbursement for medical procedures under consumer-directed healthcare accounts, including HSAs and FSAs. When it comes to egg freezing, this letter becomes an essential component to validate the procedure's medical necessity.

The LMN must be issued by a healthcare provider, often your treating physician, outlining the following crucial elements:

• Connection to medical condition: The LMN should detail the specific medical condition that necessitates egg freezing. This might include conditions like endometriosis, polycystic ovary syndrome (PCOS), or pre-chemotherapy fertility preservation, among others.
• Treatment plan: The letter should include information on how the egg freezing will help alleviate or address the identified medical issue. It may outline the plan for potential usage of the stored eggs in future fertility treatments.
• Duration of storage: The LMN should also provide an estimation of how long the eggs need to be stored. Importantly, IRS guidelines stipulate that only short-term storage, up to 12 months, may be considered a "qualified medical expense." Storage fees that exceed this time frame may not be eligible for reimbursement under current regulations.

Egg freezing and storage for potential future use without a defined medical necessity is typically not considered eligible for reimbursement. The IRS guidelines center around the concept of medical necessity, which is why the LMN is such a crucial part of this process.

Other ways to pay for egg freezing

If you’re interested in egg freezing but learn that you cannot use your HSA or FSA funds,  there are other financial avenues to explore.

Employer coverage 

Various insurance providers and employers are starting to cover egg freezing and other fertility preservation methods. Progressive companies such as Google, Apple, and Facebook have already started offering egg freezing coverage as part of their benefits package. That said, we have a long way to go before egg freezing is offered as a commonplace employer benefit, which is why our accessible egg freezing programs are helpful to so many. 

Read more in What Employers Offer Egg Freezing Benefits?

Health insurance

Unfortunately, very few insurance plans today cover the full cost of egg freezing, unless it is medically necessary. For example, if you have a medical condition that may impact your fertility, such as cancer, your insurance may cover the cost of egg freezing as part of your cancer treatment. Check with your insurance provider to see if they cover egg freezing and what the requirements are.

Read more in Does Insurance Cover Egg Freezing?

Cofertility’s Split program

At Cofertility, our Split program allows you to freeze and store your eggs *entirely for free* for 10 years, when you give half to a family who can't otherwise conceive.

To see if you qualify, take our quiz and tell us a bit about yourself. This only takes about a minute and gives a sense of what programs you might be qualified for.

Financing

There are a growing number of financing options, such as loans or payment plans like Sunfish, to help patients pay for egg freezing. These options allow you to spread the cost of the procedure over several months, making it more manageable. 

Our take: IRS should rethink its stance on elective egg freezing 

As healthcare technology and societal norms evolve, there is potential for the IRS regulations to adapt and become more encompassing. Advocacy in this regard is crucial. For instance, RESOLVE: The National Infertility Association and the American Society for Reproductive Medicine (ASRM) are two organizations that have been pushing for more comprehensive coverage of infertility treatments, including egg freezing.

Summing it up

Using HSA or FSA funds for egg freezing is a nuanced and complex issue, largely dependent on individual circumstances and interpretations of IRS guidelines. While it may be possible under specific medical circumstances, women considering egg freezing for non-medical reasons may face more significant challenges in utilizing these funds.

As we navigate this evolving landscape, and encourage the expansion of “qualified medical expenses,” you’ll want to seek professional tax advice, and explore other financial avenues towards making egg freezing more accessible. Through our collective voices and efforts, we can work towards making fertility preservation a widely recognized and supported aspect of women's healthcare.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive.

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.

At Cofertility, we believe that freezing your eggs should be an empowering experience that more women have access to. With our Keep program, you can more affordably freeze your eggs with partnerships that lighten the financial load and ongoing support from our team.  As a Keep member, you’ll benefit from discounts on things like consultations, treatment and cycle fees, and storage costs. You’ll also access our private Freeze by Co community, where you can connect with our team and with other women going through the egg freezing process at the same time.

Freezing your eggs is a big life decision — much like moving cross country, going back to school, or getting married. The process is often filled with unknowns, difficult to navigate, and financially inaccessible. Our goal is to support you every step of the way, and make it the best experience possible.

Why should I freeze my eggs, anyway? 

Whether you’re thinking about going back to school, wanting to invest in your career, unsure whether you want to have kids yet, or just haven’t found your ‘person,’ there are many different reasons why freezing your eggs might make sense for you. Over 70% of our members cite building their career or going back to school as the most important factors to them right now. Egg freezing is a way to keep your reproductive options open for later by preserving younger, healthier eggs for future use. What’s more, the prime time for freezing your eggs is actually a lot earlier than you think. Freezing your eggs while you’re still in your 20s can boost your chances of successful pregnancy, no matter your age when you decide to start your family. 

Overall, deciding to freeze your eggs can do more than provide family building options later in life. Going through the process of retrieving and freezing your eggs can give you insights into your health and offer you peace of mind about how you’ll accomplish your goals.

To learn more, check out our articles: Why Do People Freeze Their Eggs? Should I Be Thinking About It Too?, What’s the Best Age to Freeze My Eggs?, and When Should I Freeze My Eggs? 

How do I know if I am eligible for the Keep program? 

Unlike our Split program, where you freeze your eggs for free when donating half to a family that can’t otherwise conceive, the Keep program’s eligibility requirements are much less stringent. In fact, the decision to freeze your eggs through Keep will ultimately be between you and your doctor, once you both review your medical history and test results.

For example, while you must be between 21-33 to participate in Split, you can still take part in the Keep program as long as you are under age 40 (these are the clinics’ rules, not ours).

So whether you don’t qualify for egg donation, or simply are not interested in egg donation, the Keep program could be a great option for you. 

What are the benefits of the Keep program? 

By freezing your eggs through Cofertility’s Keep program, you’ll gain access to:

• Preferred and vetted fertility clinic recommendations in many major markets, with discounted or free consultations 
• Skip the line — many fertility clinics have months-long waitlists for egg freezers. If you work with one of our partner clinics, we’ll help get you through faster
• Special discounts on long-term egg freezing storage
• Dedicated, 1:1 support from our Member Advocates to help you through every step of your egg freezing journey
• Access to our members-only community of women in all stages of their egg freezing journey and direct, free access to fertility experts 
• Financial support and resources through our financing partner, Sunfish (waived application and membership fees for all Cofertility members)

What does the Keep process look like? 

Step 1: Fill out the intro quiz 

To kick off the process, take our quiz and tell us a bit about yourself. This only takes about a minute and gives a sense of what programs you might qualify for.

Step 2: Provide your desired location and timeline for the egg freezing process 

After you complete the intro quiz, you’ll receive an email from us with more information on our programs. We’ll ask you to respond back with more details on where (in which city or cities) and when you would like to freeze your eggs. This allows us to make custom recommendations tailored to your needs! 

Step 3: Receive fertility clinic recommendation and pricing 

We aim to share at least one pre-vetted, recommended fertility clinic near you based on patient reviews, outcomes, and success rates. We know this process can be expensive (between $10,000 to $20,000 per cycle), so we do our best to get you the best pricing. With many clinics, we negotiate preferred pricing for our Keep members, including discounted cycle fees and/or initial consultations. 

If we don’t yet have a clinic recommendation near you, we’ll add you to our waitlist for that city and reach out as soon as we do. Keep members are welcome to work with any clinic of their choosing and still be part of the program, but we aim to have at least one recommendation in each major market. 

Step 4: Set up an initial consultation with a fertility clinic 

Once you decide which clinic you would like to work with, we’ll help get you set up for an initial consultation with a reproductive endocrinologist. Most preferred clinics have guaranteed turnaround times for our members - so no more long waitlists! 

Step 5: Get added to the private Freeze by Co members-only community 

Once you book your initial consultation and confirm that you would like to be part of our Keep program, we’ll add you to the members-only, Freeze by Co community. This is where you can connect with others going through egg freezing at the exact same time and receive direct access to egg freezing experts through Q&As and webinars. 

Step 6: Get support with every step of your egg freezing journey 

We will stay coordinated with your fertility clinic and help guide you through every step of the egg freezing process. We’re here for you in a ‘been there, done that’ kind of way, and we will work with our medical advisors to get you answers to any questions you have! 

We also have several informative articles on our website that can serve as a primer for what to expect with the egg freezing process: 

• I Want to Freeze My Eggs: What's the Egg Retrieval Process Really Like? 
• What are the First Steps Towards Freezing my Eggs? 
• Everything You Need to Know About Egg Freezing 
• The Egg Freezing Process: a First-Timer’s Overview 
• A Step-by-Step Guide to Freezing Your Eggs 

How much does it cost to be a Keep member? 

There is no fee to join the Keep program. The only costs you’ll pay are those directly related to your cycle (e.g., consultation fees, cycle fees, storage fees, and medications). There are a variety of different ways to fund your egg freezing journey, and we are flexible to work with you however it makes sense based on your needs. 

Have coverage through your employer or insurance for egg freezing? You can still use these benefits and join our Keep program! Your general health insurance may cover some of your screening and upfront blood work, so we suggest discussing it with the clinic you move forward with if you go through our Keep program.

Need help financing your cycle? We got you! We've partnered with lenders to offer you fertility financial resources. Sunfish offers the most comprehensive marketplace of financial options for egg freezing up to $100,000 at industry-low rates. Some clinics may also offer financing programs for egg freezing cycles. 

To learn more, check out our article: How to Pay for Egg Freezing 

Where do I sign up? 

There is no cost to join the Keep program. Take our quiz today and get your egg freezing process started!

Egg freezing, formally known as oocyte cryopreservation, is a medical procedure that allows you to preserve your fertility by retrieving, freezing, and storing your eggs for future use. 

Egg freezing is an exciting and empowering option for those who want to take control of their fertility and pursue their life goals on their own timeline. But where should you start? In this article, we’ll share some factors to consider when selecting an egg freezing clinic that will give you the confidence and support you need throughout the process.

Reputation

When it comes to choosing an egg freezing clinic, reputation is key. It’s not just about the clinic, it’s also about the doctor you will work with. There are a few ways to find out the reputation of a clinic and specific doctor. You can research online, read reviews, and ask for recommendations from your doctor or friends who have undergone the procedure.

If you work with Cofertility to freeze your eggs, we have a list of vetted fertility clinic partners we will share to help you make a confident choice.

Experience and outcomes

Now that you’ve narrowed down the list, you can use the Society for Assisted Reproductive Technology (SART) website to look up data on specific fertility clinics. SART data provides detailed information on the number of cycles performed, age of patients, and success rates for various fertility treatments, including egg freezing. By reviewing the SART data, you can gain insight into a clinic's expertise and quality of care for egg freezing. Here’s how:

1. Go to SART's website at www.sart.org.
2. Click on "Clinic Data" in the top menu and select "National Summary Report."
3. Choose the year for which you want to view the data.
4. Use the search bar to find the clinic you are interested in.
5. Click on the clinic's name to view their data.
6. Look for the section titled "Egg Freezing Cycles" to see the clinic's success rates for egg freezing.
7. Review the clinic's success rates for egg freezing and compare them to the national average.

Keep in mind that success rates alone may not give a complete picture of a clinic's quality. SART may also not be helpful when looking up newer clinics, as the data takes about two years to post. If you’re working with a newer clinic, you can look up the doctor’s previous clinic to learn more about their past track record.

Accreditation and certification

To ensure that you receive the highest quality care, look for clinics that are accredited and certified by respected organizations. These certifications demonstrate that the clinic has met rigorous standards for safety, quality, and performance. Specifically, look for:

• The Joint Commission (JCAHO) is an independent, non-profit organization that accredits and certifies healthcare organizations in the United States. A fertility clinic that is accredited by the Joint Commission has met rigorous standards for quality and safety.
• College of American Pathologists (CAP) is a professional organization that accredits laboratories and pathology services. A fertility clinic that is accredited by the CAP has demonstrated proficiency in laboratory techniques and quality control.
• Society for Assisted Reproductive Technology (SART) reporting, as described in the section above. 

At Cofertility, we only partner with clinics that report outcomes to SART and have a CAP certified lab.

Technology and facilities

Egg freezing technology has come a long way in recent years, so it's important to choose a clinic that uses the latest equipment and facilities. By finding a clinic with state-of-the-art technology, you can be more confident that your eggs will be frozen and stored in the best possible conditions. Plus, a modern and comfortable clinic environment will help you feel relaxed and at ease during the process.

Here are some questions you can ask the clinic to get a better idea of their capabilities:

• What type of equipment do you use for egg freezing?
• How long have you been using this equipment, and how often do you update it?
• What is the success rate of your egg freezing procedure?
• Do you use vitrification or slow freezing? (You want a clinic that uses vitrification)
• What measures do you take to ensure the quality and safety of the eggs during the freezing process?
• Can you provide details about your laboratory and facilities for egg freezing, including any recent upgrades or renovations?
• Do you participate in research or clinical trials related to egg freezing?

By asking these questions, you can get a better sense of the clinic's commitment to using the latest technology and techniques for egg freezing, as well as their focus on quality and safety. A reputable and modern clinic will be happy to answer your questions and provide you with information to help you make an informed decision about your egg freezing journey.

The team

The staff at an egg freezing clinic can make all the difference in your experience. Look for clinics that have a team of knowledgeable, caring professionals who will guide you through every step of the process. The best clinics offer ongoing support and counseling to ensure that you feel confident and empowered throughout your egg freezing journey. During a consult, you’ll get to meet with the doctor and see if you click before moving forward.

Plus, if you work with us, you’ll get access to our team to help you every step of the way. 

Cost 

And last, but definitely not least, cost is an important consideration when choosing an egg freezing clinic. There’s no way around it, egg freezing is expensive. The typical egg freezing cycle can cost anywhere from $10,000 to $20,000 plus the cost of storage. A few clinics list their pricing on the website, but for most clinics, you will need to ask. Keep in mind that the price from the clinic does not usually include medications or long-term storage.  

Read more in How to Pay for Egg Freezing.

Cofertility can help

Freeze by Co offers women a chance to freeze their eggs for free when they donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, Freeze by Co offers lower prices on things like consultations and storage, along with access to our community of women going through the process at the same time. ‍