Follistim AQ (follitropin beta) — United Healthcare
Ovulation induction
Initial criteria
- For Ovulation Induction: ALL of the following:
- • Diagnosis of ovulatory dysfunction
- AND • One of the following exists: Anovulation OR Oligo-ovulation OR Amenorrhea
- AND • Other specific causative factors (e.g., thyroid disease, hyperprolactinemia) have been excluded or treated
- AND • Infertility is not due to primary ovarian failure
- AND • For induction of ovulation
Approval duration
2 months