Pregnyl — United Healthcare

Initial criteria

• Diagnosis of infertility AND For the development of multiple ovarian follicles AND Patient has been or will be pre-treated with a follicular stimulating agent (e.g., gonadotropin, clomiphene citrate, letrozole)
• OR Used for fertility preservation AND Individual will undergo gonadotoxic therapy (e.g., exposure to cytotoxic agents, invasive surgery, prolonged hormonal ovarian suppression, radiation therapy) AND Will be used as part of an assisted reproductive technology (e.g., in vitro fertilization) procedure

Approval duration

2 months