Most Baylor Scott & White Health Plan members have coverage for the diagnostic evaluation of infertility but treatment of infertility is not a benefit for most plans unless specifically purchased as a rider. Where infertility treatment is a covered benefit under a plan, interventions are typically limited to in vitro fertilization (IVF). Prior authorization is required for fertility preservation services, and fertility preservation and storage of reproductive material may not be a benefit for some plans; when covered, services may be limited to standard retrieval, isolation, and cryopreservation. Hormonal therapies/medications and storage of unfertilized genetic materials may be excluded depending on the member's benefit document.

The excerpt reviewed does not contain a separate, fully detailed exclusions section within these chunks. The policy history notes prior updates (including corrected exclusions and clarifications added in 2024–2025) but the specific exclusion language beyond the summary that treatment is not a benefit for most plans appears only in the plan-level Evidence of Coverage (EOC) or SPD; reviewers should refer to those member-specific documents for the definitive exclusion and limitation text.

Policies referencing state or legislative requirements and prior revisions are documented in the policy update log; any plan-level application of exclusions or riders should be confirmed against the applicable EOC/SPD and the policy change history.

The policy identifies a number of services that BSWHP considers experimental, investigational, or unproven for the treatment or evaluation of infertility. Examples listed include: acupuncture; hyperbaric oxygen therapy for IVF; intravaginal culture devices (e.g., INVOcell); various immune treatments (peri-implantation glucocorticoids, anti‑TNF agents, leukocyte immunization, IVIG); computer-assisted sperm motion analysis; co‑culture techniques for embryo/oocyte culture; direct intraperitoneal or intrafollicular insemination; endometrial receptivity testing (e.g., Endometrial Function Test™, ERA); fine needle aspiration mapping; hemizona test; hyaluronan binding assay; sperm viability tests when used diagnostically; use of sperm precursors; manual soft tissue therapies for pelvic adhesions; laser removal of necrotic blastomeres from cryopreserved embryos; reactive oxygen species testing; time-lapse embryo imaging (e.g., EmbryoScope); uterine transplantation; vaginal microbiome testing; and saline-air infused sono-hysterosalpingogram variants (e.g., femVue®).

Within the provided excerpt there are no explicit statements formatted as ‘not medically necessary’ for specific services beyond the list of experimental or investigational items. The policy change log indicates prior revisions and corrections to exclusions, suggesting editorial updates have been made in earlier versions, but the reviewed chunks do not include separate, formalized 'not medically necessary' language; determination of not medically necessary should follow the policy criteria and member plan benefits.

Infertility is defined here as the inability to conceive or carry a pregnancy to live birth after a period of unprotected intercourse without contraception — specifically 12 months for individuals under age 35 or 6 months for those aged 35 or older. Causes of infertility include male factor, ovulation disorders, tubal damage, endometriosis, cervical or coital factors, and unexplained infertility. Evaluation typically follows a stepwise approach based on history and prior results and may include history and physical, targeted laboratory testing (TSH, prolactin, FSH, LH, estradiol, progesterone), pelvic ultrasound, hysterosalpingography, sonohysterography, hysteroscopy, diagnostic laparoscopy, and male evaluation such as semen analysis and endocrine testing. Iatrogenic infertility refers to fertility loss caused by medical treatment (most commonly cancer therapy), and fertility preservation options (including cryopreservation) are considered when planned gonadotoxic therapy is anticipated.