Gonal-f — United Healthcare
Male Hypogonadotropic Hypogonadism
Preferred products
- Follistim AQ
Initial criteria
- Diagnosis of male primary or secondary hypogonadotropic hypogonadism
- For induction of spermatogenesis
- Infertility is not due to primary testicular failure
- If request is for Gonal-f, history of failure, contraindication, or intolerance to Follistim AQ
Approval duration
3 months