IVF Costs $50K on Average Across 2.3 Cycles: Building a Fertility Treatment Tracker

General
1

We just finished our second IVF cycle. The emotional rollercoaster is one thing, but the financial complexity caught me completely off guard. IVF treatment in 2026 averages $12,000-$20,000 for a basic cycle, but once you add medications ($2,000-$7,000 per cycle) and common add-ons, you’re looking at $15,000-$30,000+ per cycle.

And the average number of cycles to achieve a live birth? 2.3 cycles.

Here’s how I’ve been tracking it in Beancount, because spreadsheets just weren’t cutting it.

The Account Structure

I separated fertility expenses into their own hierarchy to make reporting easier:

2024-06-01 open Expenses:Medical:Fertility:Clinic
2024-06-01 open Expenses:Medical:Fertility:Medications
2024-06-01 open Expenses:Medical:Fertility:Lab
2024-06-01 open Expenses:Medical:Fertility:Monitoring
2024-06-01 open Expenses:Medical:Fertility:Storage  ; Embryo storage
2024-06-01 open Assets:FSA:Medical
2024-06-01 open Assets:HSA
2024-06-01 open Liabilities:Medical:PaymentPlan

Tracking Multiple Cycles

I use tags to separate cycles and track outcomes:

2025-08-15 * "Shady Grove" "IVF Cycle 1 - Retrieval" #ivf-cycle-1 ^cycle1
  Expenses:Medical:Fertility:Clinic   8500 USD
  Assets:FSA:Medical                  -3200 USD
  Assets:HSA                          -2000 USD
  Assets:Bank:Checking                -3300 USD
    outcome: "6 eggs, 4 fertilized, 2 blasts"
    
2025-08-20 * "CVS Specialty" "Gonal-F and Menopur" #ivf-cycle-1 ^cycle1
  Expenses:Medical:Fertility:Medications  4200 USD
  Assets:FSA:Medical                      -800 USD
  Assets:Bank:Checking                   -3400 USD

FSA/HSA Tracking

Good news: IVF is eligible for reimbursement with FSA, HSA, and HRA. The IRS allows deduction of fertility treatments including IVF, IUI, and surgery.

Important limitation: Long-term embryo storage (typically greater than one year) is NOT FSA-eligible because it’s not considered an immediate medical need.

2025-12-15 * "Annual embryo storage" "Year 1"
  Expenses:Medical:Fertility:Storage  600 USD
  Assets:Bank:Checking               -600 USD
    fsa_eligible: FALSE
    notes: "Long-term storage not covered"

The 2026 FSA Limit Challenge

The 2026 FSA limit is $3,400 per year. That covers maybe 1/4 of a single cycle’s medications. I’ve been strategic about timing:

  • Max out FSA in year 1
  • Use HSA as overflow (no use-it-or-lose-it)
  • Track what’s tax-deductible for Schedule A

Shared Risk Programs

Some clinics offer “Shared Risk” or refund programs - you pay more upfront, but get a partial refund if treatment fails. I track these as separate liabilities:

2025-06-01 * "Shady Grove" "Shared Risk Program - 3 cycles"
  Liabilities:Medical:SharedRisk     -32000 USD
  Assets:Bank:Checking               -32000 USD
  
; If refund is received after failure
2026-03-01 * "Shady Grove" "Shared Risk Refund - 70%"
  Assets:Bank:Checking                22400 USD
  Liabilities:Medical:SharedRisk      22400 USD

The Emotional Metadata

This might seem strange, but I add metadata that helps me process things when I look back:

2026-01-10 * "Clinic" "Cycle 2 Transfer" #ivf-cycle-2
  Expenses:Medical:Fertility:Clinic   2500 USD
  Assets:Bank:Checking               -2500 USD
    beta_result: "positive"
    notes: "Finally. 14 months and $47,000 later."

Has anyone else tracked fertility treatment? I’d love to compare approaches, especially around:

  • Insurance reimbursement tracking (my employer covers 50%)
  • Multi-year FSA optimization
  • Separating “sunk costs” from “ongoing” expenses
2

Thank you for sharing this. We went through three cycles before our daughter was born, and the financial tracking was essential to my mental health - it gave me something concrete to focus on.

Insurance Reimbursement Tracking

My approach for the 50% employer coverage:

2025-09-01 * "Clinic" "Cycle 1 - Due from insurance"
  Expenses:Medical:Fertility:Clinic   8500 USD
  Assets:Bank:Checking               -8500 USD
  
2025-09-15 * "Insurance" "Reimbursement - Cycle 1"
  Assets:Bank:Checking                4250 USD
  Income:Insurance:MedicalReimbursement  -4250 USD

I track it as income rather than reducing the expense, because I want to see the true cost of the procedure in my reports, then reconcile what I actually paid net of insurance separately.

One Thing I Learned Too Late

Ask your clinic about medication discount programs. Manufacturers like EMD Serono (Gonal-F) and Ferring (Menopur) have compassionate care programs that can reduce medication costs by 25-75%. I didn’t find out until cycle 2 and left thousands on the table.

Wishing you the best on your journey.

3

The emotional metadata comment really resonates. Financial tracking during fertility treatment is weird - you’re simultaneously trying to be analytical about costs AND processing deep feelings about outcomes.

My Alternative Approach: Separate Ledger

I actually kept fertility in its own Beancount file that I include in my main ledger:

; main.beancount
include "fertility.beancount"

This way I can:

  • Run reports on just fertility expenses
  • Hide it when I don’t want to see it
  • Share the main file with my spouse without the emotional weight

Tax Deduction Tracking

Don’t forget: medical expenses above 7.5% of AGI are deductible on Schedule A. For a household making $150K, that’s $11,250. A single IVF cycle can easily exceed that threshold.

I tag deductible expenses:

2025-08-15 * "Clinic" "IVF Cycle 1" #tax-deductible-2025
  Expenses:Medical:Fertility:Clinic   8500 USD
  Assets:Bank:Checking               -8500 USD

Then query at year end:

SELECT SUM(position) WHERE #tax-deductible-2025

This tells me exactly what to report to my CPA.