All coverage is subject to the terms and conditions of the plan. The following discussion is applicable only to members whose plans cover infertility services. Alternately, a woman without a male partner may be considered infertile if she is unable to conceive or produce conception after at least 12 cycles of donor insemination 6 cycles for women aged 35 or older.
However, this definition of infertility may vary due to state mandates and plan customization; please check plan documents. Most plans exclude coverage of infertility services for couples in which either of the partners has had a previous sterilization procedure, with or without surgical reversal, and for females who have undergone a hysterectomy, clomid and ovulation timing.
Please check benefit plan descriptions for details. Please check benefit plan descriptions. Advanced reproductive technology in vitro fertilization services are considered medically necessary for women with premature ovarian failure who are less than 45 years of age.
Infertility services are considered not medically necessary once pregnancy is established and a fetal heartbeat is detected. Infertility services beyond 8 weeks of pregnancy are not considered medically necessary.
The following laboratory studies are considered experimental and investigational for infertility:. Many plans exclude coverage of home pregnancy tests and home ovulation test kits. The medications listed above may not be covered for clomid and ovulation timing without pharmacy benefit plans; in addition, some pharmacy benefit plans may exclude or limit coverage of some or all of these medications.
There is a lack of reliable evidence that any one brand of FSH is superior to other brands for medically necessary indications. GnRH antagonists ganirelix acetate Antagoncetrorelix acetate Cetrotide are considered medically necessary for women undergoing assisted reproduction techniques ART to prevent premature LH surge in women undergoing controlled ovarian stimulation with gonadotropins, allowing the follicles to mature for planned oocyte collection.
Many plans exclude coverage for infertility injectable medications; other plans may limit coverage of ovulation induction cycles clomid and ovulation timing menotropins to six 6 per lifetime.
Please check plan documents for details. Semen analysis volume, pH, liquefaction time, sperm concentration, total sperm number, clomid and ovulation timing, motility forward progressionmotile sperm per ejaculate, vitality, clomid and ovulation timing, round cell differentiation white cells versus germinalmorphology, clomid and ovulation timing, viscosity, agglutination is considered medically necessary for the evaluation of infertility in men.
Seminal alpha-glucosidase, zinc, citric acid, and acid phosphatase are considered experimental and investigational. The following sperm function tests are considered experimental and investigational:.
Many plans that otherwise cover infertility treatments exclude coverage for infertility injectable medications. Most plans exclude coverage for reversal of sterilization procedures. This would include vasectomy.
Under most Aetna benefit plans, self-administered prescription medications are covered under the pharmacy benefit. Many Aetna plans that otherwise cover infertility services exclude coverage of fees associated with donor insemination including semen donor recruitment, clomid and ovulation timing, selection and screening, and cryostorage of sperm. Under these plans, donor insemination would not be covered for these indications infectious disease in male partner, high risk of transmitting a genetic disorder as these do not meet the contractual definition of infertility.
Some Aetna benefit plans may exclude coverage of artificial insemination AI. For Aetna benefit plans that cover artificial insemination, coverage is typically limited to six 6 cycles per lifetime. Couples for whom natural or artificial insemination would not be expected to be effective and ART would be expected to be the only effective treatment, including:.
Coverage is limited to clomid and ovulation timing with an ART benefit; please check benefit plan descriptions. The procedure to obtain the cell sample for PGD i. However, under plans that limit coverage of ART to persons who are infertile, the in-vitro fertilization IVF procedure i. Note on IVF cycles for embryo banking: Note on oocytes used in ART cycles: Gamete intra-fallopian transfer GIFT is considered medically necessary as an alternative to IVF for women with female factor infertility.
GIFT is considered experimental and investigational for person with male factor infertility or unexplained infertility problems because there is insufficient evidence to recommend Clomid and ovulation timing over IVF for these indications.
ZIFT is considered experimental and investigational for persons with male factor infertility or unexplained infertility problems because there is insufficient evidence to recommend ZIFT over IVF for these indications. Most plans exclude coverage of infertility services for persons who have undergone sterilization.
Oocyte donation is considered medically necessary for managing infertility problems associated with the following conditions, when the infertile member is the intended recipient of the resulting embryos:.
Many Aetna plans that otherwise cover clomid and ovulation timing services exclude coverage of fees associated with oocyte donation, caffeine and bad cholesterol recruitment and selection of donors, ovarian stimulation of donors, collection of oocytes from donors, clomid and ovulation timing, and screening and storage of donor oocytes. Under plans with benefits for IVF that have this exclusion, medically necessary IVF services are covered only once an embryo is created from the donor egg.
Routine use of oocyte cryopreservation in lieu of embryo cryopreservation, oocyte cryopreservation to circumvent reproductive aging in healthy women, cryopreservation of immature oocytes, and laser-assisted necrotic blastomere removal from cryopreserved embryos are considered experimental and investigational. Some Aetna plans have a specific contractual exclusion of coverage of any charges associated with embryo cryopreservation or storage of cryopreserved cholesterol and fats. In addition, cryopreservation of embryos and oocytes other than short-term cryopreservation of embryos that are necessary for contemporaneous use in infertile persons currently under active fertility treatment, or use of cryopreserved embryos or mature oocytes in women facing infertility due to chemotherapy or other gonadotoxic therapies or gonad removal is not considered treatment of disease and is not covered.
Note on elective single embryo transfer: For infertile women with regular menstrual cycles, a mid-luteal serum progesterone measurement day 21 of a day cycle is considered medically necessary. For infertile women with irregular menstrual cycles, this test would need to be repeated at the mid-luteal phase and weekly thereafter until the next menstrual cycle starts.
Less than age 35 years: Age 35 to 39 years: Age 40 years and older: After normalization of serum testosterone levels, use Gonal F concomitantly with hCG: World Health Organization Reference Values.
Limits on the Number of Embryos to Transfer. Before proceeding to the next fresh ART cycle, frozen embryo transfer FET using cryopreserved embryos must be used if the following numbers of cryopreserved embryos are available:.
The various stages show these findings:. Infertility is a condition that is defined by the failure to achieve successful pregnancy after 12 months or more of unprotected heterosexual intercourse after six months in women over 35 years of age OR in those women, without a male partner, who are unable to conceive after at least 12 cycles of donor insemination six cycles for women over 35 years of age. The term primary infertility is applied to a couple who has never achieved a pregnancy; secondary infertility implies that at least one previous conception has taken place.
This condition may be present clomid and ovulation timing one or both sexual partners and may be clomid and ovulation timing. Diagnostic investigation of infertility includes complete physical examinations and certain testing for both partners. Infertility treatment may involve a series of procedures in an attempt to correct the cause of infertility, clomid and ovulation timing. Recurrent pregnancy loss is clomid and ovulation timing from infertility is defined by two or more clomid and ovulation timing losses.
For purposes of determining when evaluation and treatment for infertility or recurrent pregnancy loss are appropriate, pregnancy is defined clomid and ovulation timing a clinical pregnancy documented by ultrasonography or histopathologic examination. No fertility treatment other than oocyte donation has been shown to be effective for women over 40 years of age with compromised ovarian reserve. Elevated follicle-stimulating hormone FSH and estradiol levels are independent predictors of poor prognosis in older women.
Women with diminished ovarian reserve experience decreased responses to ovulation induction, require higher doses of gonadotropin, have higher in-vitro fertilization IVF cycle cancellation rates, and experience lower pregnancy rates through IVF. The guidelines state that more widespread clinic-specific data on the safety and efficacy of oocyte cryopreservation in donor populations are needed before universal donor oocyte banking can be recommended.
The guidelines state that there are not yet clomid and ovulation timing data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive clomid and ovulation timing in healthy women. The guidelines state that more data are needed before this technology should be used routinely in lieu of embryo cryopreservation. The American College of Obstetricians and Gynecologists ACOG practice bulletin on bariatric surgery and pregnancy stated that bariatric surgery should not be considered a treatment for infertility.
There is emerging evidence to suggest that a low AMH level e. More recently, the ASRM concluded: Low AMH cutpoints are fairly specific for poor ovarian reserve, but not for pregnancy. Future studies of AHM as a screening test should incorporate larger numbers of subjects in a high-risk or general risk IVF population.
An antral follicle count, commonly known as AFC, clomid and ovulation timing, also may be useful if there is an indication to perform transvaginal ultrasonography. In infertile women, they can be used to predict low oocyte yield and treatment failure in women undergoing IVF. These markers seem to be affected by common ovarian toxicants, such as smoking, which advance the age at menopause.
Although available for commercial use, home test kits have not been shown to predict fertility or infertility in the general population. Clinical use of these markers is limited by the variety of assays, lack of definitive thresholds, and their intercycle variability in older women. Results should be conveyed with caution when highly discrepant with age, in the obese, and in women clomid and ovulation timing irregular menstrual cycles, clomid and ovulation timing.
The author stated that further research is needed to assess their predictive value for determining fertility in the general population. Nelson et al stated that individualization of controlled ovarian stimulation COS for assisted conception is clomid and ovulation timing by variable ovarian response to FSH.
These researchers hypothesized that AMH may facilitate treatment strategies for women undergoing COS, to optimize safety and clinical pregnancy rates. A prospective cohort study of patients in 2 centers with differential COS strategies based on a centralized AMH measurement was performed, clomid and ovulation timing.
The authors concluded that the use of circulating AMH to individualize treatment strategies for COS may result in reduced clinical risk, optimized treatment burden and maintained pregnancy rates, and is worthy of prospective randomized examination. Nardo et al evaluated the clinical value of basal AMH measurements compared with other available determinants, apart from chronologic age, in the prediction of ovarian response to gonadotrophin stimulation.
All patients were followed prospectively and their cycle outcomes recorded. Out of the women, clomid and ovulation timing, were defined as normal responders, 15 as poor responders, and 16 as high responders, clomid and ovulation timing. Subjects in the poor response group were significantly older then those in the other 2 groups.
Anti-Mullerian hormone prediction clomid and ovulation timing ovarian response was independent of age and polycystic ovarian syndrome PCOS. Anti-Mullerian hormone cutoffs of greater than 3.
The authors concluded that circulating AMH has the ability to predict clomid and ovulation timing and poor response to stimulation with exogenous gonadotrophins. The primary end point was chemotherapy-related amenorrhea CRA greater than or equal to 12 months of amenorrhea following chemotherapy. The median age of the patients at chemotherapy was At enrollment, median follow-up since chemotherapy was 2.
The authors concluded that AMH and inhibin B are 2 additional measures of post-chemotherapy ovarian function in late reproductive-aged breast cancer survivors. All randomized controlled trials were included if they addressed the research question and provided outcome data for intervention and control participants. A total of 10 studies subfertile couples were included.
Results of the meta-analysis demonstrated no difference in outcome measures and adverse events in the routine use of adjuvant GH in IVF protocols. However, meta-analysis demonstrated a statistically significant difference in both live birth rates and pregnancy rates favoring the use of adjuvant GH in IVF protocols in women who are considered poor responders without increasing adverse events, OR 5.