Diagnosis: Low AMH level
Treatment: In vitro fertilization
The insurer denied the In vitro fertilization.
The denial is upheld.

The patient is a female. She presented interested in fertility preservation. She did not have a diagnosis of infertility as she had just stopped her contraception. She reported a low AMH (anti-mullerian hormone) level (0.65).

The patient underwent IVF (in vitro fertilization), though it is unclear from the submitted material how many IVF (in vitro fertilization) cycles she had, and she has currently one euploid embryo frozen. The patient is requesting coverage for additional IVF (in vitro fertilization) cycles.

No, the In vitro fertilization is not medically necessary.

According to ASRM (American Society for Reproductive Medicine), infertility is defined by the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after six months for women over age 35 years.

This patient does not have infertility as she never tried and failed to conceive. She presented for fertility preservation through embryo freezing and she had just stopped her birth control method (NuvaRing). As such, this patient does not have any sickness or injury that requires treatment.

IVF (in vitro fertilization) for this patient is not medically necessary as the patient does not have a diagnosis of infertility. IVF (in vitro fertilization) is being requested for fertility preservation. The patient may not need to preserve her fertility. She could try conceiving naturally when she is ready to get pregnant. Please note that fertility preservation in this patient is an elective procedure. The patient does not have any malignancy or medical condition that would lead to an inability to reproduce in the future.

Note that studies have shown clearly that a low AMH (anti-mullerian hormone) does not mean infertility, and patients with low AMH (anti-mullerian hormone) can conceive easily when ready to conceive.

In the absence of a diagnosis of infertility, additional IVF (in vitro fertilization) cycles are not medically necessary as supported by current medical literature and any applicable diagnostic/treatment guidelines.

This patient already has a euploid frozen embryo. If she is interested in conceiving, she could proceed with transfer of this embryo. The odds of conception and live birth with a euploid embryo are excellent.

In summary, in the absence of a diagnosis of infertility, additional IVF (in vitro fertilization) cycles are not medically necessary.