Diagnosis: Female Infertility
Treatment: In vitro fertilization (IVF) cycle
The health plan denied the IVF cycle as not medically necessary.
The health plan's determination is upheld.

The patient is a female who has a euploid embryo and is seeking to use a gestational carrier. At issue is the medical necessity of another in vitro fertilization (IVF) cycle to create additional embryos.

The health plan's determination of medical necessity is upheld in whole.

The requested health service/treatment of IVF cycle is not medically necessary for this patient. The patient has a euploid embryo which should yield at least a 50% (percent) chance of pregnancy for the treatment of infertility. Thus, at this time, additional embryos are not medically necessary for a reasonable chance of yielding a child.