General information...

Clinical Coverage Criteria

ART/Infertility Services

ART/Infertility Eligibility Criteria

Evaluation Requirements for Intrauterine Insemination (IUI)

Evaluation Requirements for In Vitro Fertilization (IVF)

Intrauterine Insemination (IUI) Services

In Vitro Fertilization... In Vitro Fertilization due to Inadvertent Ovarian Hyperstimulation.

Donor Egg

Transfer and Frozen Transfer

Single Embryo (SET) Embryo (FET) Intra-Cytoplastic Sperm Injections (ICSI)

Assisted Hatching (AH)

Gamete and Zygote Intrafallopian Transfer (GIFT & ZIFT)

Donor Sperm

Assisted Reproductive Technology Services – New Hampshire Products

• Microsurgical Epididymal Sperm Aspiration (MESA)
• Testicular Sperm Extraction (TESE)
• History of Prior Sterilization Reversal

Cryopreservation

Clinical Coverage Criteria for Cryopreservation of Sperm, Oocytes, or Embryos.

Limitations Administrative Process

References Approval