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Understanding infertility and what you can do about it
Understanding infertility and what you can do about it
Infertility is a common problem. According to the Centers for Disease Control and Prevention (CDC), about 10 percent of U.S. women ages 15 through 44 years have difficulty getting pregnant or staying pregnant.1
Both women and men can have problems that cause infertility. About one-third of infertility cases can be connected to the woman. Another third of the cases of infertility can be connected to the man. In the remainder of instances, a cause can’t be found.
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How long should you try to get pregnant before calling your doctor? Most experts suggest trying for at least 1 year. If you are 35 or older, see your doctor after 6 months of trying. Your chances of having a baby decrease rapidly every year after you turn 30.
Some health issues also increase the risk of infertility. So you should talk to their doctors if they have:
- Irregular periods or no menstrual periods
- Very painful periods
- Endometriosis
- Pelvic inflammatory disease
- More than one miscarriage
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology (ART). These treatments often may be combined. In most cases infertility is treated with prescription drugs or surgery.
Doctors recommend specific infertility treatments based on:
- Test results
- How long the couple has been trying to get pregnant
- The age of both the man and woman
- The overall health of the partners
If your doctor is recommending In vitro fertilization (IVF), the U.S. Centers for Disease Control and Prevention website may help you understand your chances of having a successful IVF cycle, based on your personal situation.
You can find out if you have coverage for infertility care. Just call the Member Services number on the back of your insurance card. Member Services also can tell you if you have a specific network of providers who give this care. You can also refer to your benefit plan documents for details regarding infertility coverage, which are available through your member website at aetna.com.
You do not need to obtain precertification in order to see a physician to determine why you are having trouble getting pregnant, or to start orally medicated, timed intercourse cycles.
Once there is a plan for infertility treatment, your provider will submit the precertification request. Infertility treatment includes ovulation induction with injectable infertility medicines, artificial insemination or advanced reproductive technology (ART).
If you plan to start treatment for infertility and have coverage through Aetna, your provider may initiate the treatment request online using our Availity provider portal. Providers may upload clinical documentation, check the status of precertification requests, and also make changes to existing requests using the provider portal.
For Infertility procedure codes, you may refer to our Infertility code mapping tool (PDF) for guidance.
Failure to complete the Infertility services precertification information request form (PDF), and submitting applicable medical records necessary to perform a clinical review, may delay the review or result in a denial, due to lack of information needed to make a determination.
The Clinical Policy Bulletins referenced will be used as a resource in decision making.
We encourage you to review Clinical Policy Bulletin 0327: Infertility, and Clinical Policy Bulletin 0358: Invasive Prenatal Diagnosis of Genetic Diseases before you complete the precertification request form. Applicable criteria may vary due to state mandates, and plan customization; please check plan documents for plan-specific information.
If you need help finding infertility doctor that participates in your plan, use our provider search tool to find a reproductive endocrinologist.
Aetna has an Institute of Excellence (IOE) infertility network, which includes a limited network of providers with outstanding performance. They offer high-quality, high-value infertility care. You can also find these providers by using our provider search tool.
Check with your plan to confirm if you need to use an IOE for infertility services.
IOE infertility facility listing (PDF)
IOE infertility facility listing Spanish (PDF)
‘The clinics we select meet high medical standards and have a demonstrated record of successful treatment outcomes. Women have access to doctors and clinics that can improve their chances for healthy pregnancies and healthy babies.’
— Joanne Armstrong, MD
Senior Medical Director and Clinical Head of Women’s Health
The Centers for Disease Control and Prevention offers informational videos on several topics:
1Centers for Disease Control and Prevention. Infertility Found. Page last updated August 30, 2018.
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For general health information only. Information is not a substitute for diagnosis or treatment by a physician or other health care professional. Health benefits and health insurance plans contain exclusions and limitations. Not all services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change.
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