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ModifiedBluecross IdahoPolicy MP 4.02.504

Reproductive Techniques

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This policy addresses medical necessity and investigational status for selected assisted reproductive techniques, cryopreservation services, and intracytoplasmic sperm injection. Coverage remains subject to the member-specific benefit plan, applicable law, state mandates, contract limitations, and line-of-business exceptions.

Policy Summary

PayerBluecross Idaho

PolicyReproductive Techniques

Policy CodePolicy N/A

Change TypeModified — new medically necessary cryopreservation indications

Effective DateNov 1, 2026

Last ReviewJul 30, 2026

Next Review DateN/A

Key ActionVerify the member-specific benefit plan before determining coverage.

SourceLink

POLICY UPDATE CHANGES

New medically necessary indications added for oocyte and sperm cryopreservation.

4Medically necessary technique categories

4Investigational technique categories

3Cryopreservation criteria required

2New cryopreservation categories

Medical Necessity and Investigational Status

Medically necessary reproductive techniques

The following reproductive techniques are considered medically necessary.

At least one of the following

Blastocyst transfer
Adult testicular tissue cryopreservation: Cryopreservation of testicular tissue in an adult man with azoospermia as part of an intracytoplasmic sperm injection procedureAdult man with azoospermia; performed as part of an ICSI procedure
ICSI for male factor infertility: Intracytoplasmic sperm injection for male factor infertilityMale factor infertility

Policy Summary

PayerBluecross Idaho

PolicyReproductive Techniques

Policy CodePolicy N/A

Change TypeModified — new medically necessary cryopreservation indications

Effective DateNov 1, 2026

Last ReviewJul 30, 2026

Next Review DateN/A

Key ActionVerify the member-specific benefit plan before determining coverage.

SourceLink

On This Page

Mature oocyte and sperm cryopreservation

Cryopreservation of mature oocytes and sperm is considered medically necessary when all of the following criteria are met.

All criteria required

Post-pubertal: The individual is post-pubertalPost-pubertal
Treatment-related anticipated infertility: Anticipated infertility is due to medical or surgical treatment such as gonadotoxic therapy or bilateral oophorectomyGonadotoxic therapy or bilateral oophorectomy
Examples of gonadotoxic therapy include chemotherapy and radiation therapy.
Permitted cause of anticipated infertility: The anticipated infertility is not the result of normal reproductive aging or sterilization services when those services are not for treatment of an illness, injury, or diseaseNot normal reproductive aging; not non-therapeutic sterilization

Investigational techniques

The following reproductive techniques are considered investigational.

Any of the following

Assisted hatching
Embryo co-culture: Co-culture of embryos
Prepubertal testicular tissue preservation: Cryopreservation or storage and thawing of testicular tissue in prepubertal boysPrepubertal boy
ICSI without male factor infertility: Intracytoplasmic sperm injection in the absence of male factor infertilityNo male factor infertility

Billing and Procedure Codes

CPTCPT

54500	Biopsy of testis, needle.
54505	Biopsy of testis, incisional (separate procedure).
54800	Biopsy of epididymis, needle.
55400	Vasovasostomy, vasovasorrhaphy.
55870	Electroejaculation.
58321	Artificial insemination; intra-cervical.
58322	Artificial insemination; intra-uterine.
58323	Sperm washing for artificial insemination.
58970	Follicle puncture for oocyte retrieval, any method.
58974	Embryo transfer, intra-uterine.

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HCPCSHCPCS

S4011	In vitro fertilization, including but not limited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development.
S4013	Complete cycle, gamete intrafallopian transfer (GIFT), case rate.
S4014	Complete cycle, zygote intrafallopian transfer (ZIFT), case rate.
S4015	Complete in vitro fertilization cycle, case rate.
S4016	Frozen in vitro fertilization cycle, case rate.
S4017	Incomplete cycle, treatment cancelled prior to stimulation, case rate.
S4018	Frozen embryo transfer procedure cancelled before transfer, case rate.
S4020	In vitro fertilization procedure cancelled before aspiration, case rate.
S4021	In vitro fertilization procedure cancelled after aspiration, case rate.
S4022	Assisted oocyte fertilization, case rate.

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Reproductive laboratory and assisted reproduction servicesCPT | HCPCS

89354	Thawing of cryopreserved reproductive tissue, testicular/ovarian
89356	Thawing of cryopreserved oocytes, each aliquot
89398	Unlisted reproductive medicine laboratory procedure
S4011	In vitro fertilization, including identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development
S4013	Complete cycle, gamete intrafallopian transfer (GIFT), case rate
S4014	Complete cycle, zygote intrafallopian transfer (ZIFT), case rate
S4015	Complete in vitro fertilization cycle, case rate
S4016	Frozen in vitro fertilization cycle, case rate

Fertility cycle, donor, cryopreservation, and ovulation-induction servicesHCPCS

S4017	Incomplete cycle, treatment cancelled prior to stimulation, case rate
S4018	Frozen embryo transfer procedure cancelled before transfer, case rate
S4020	In vitro fertilization procedure cancelled before aspiration, case rate
S4021	In vitro fertilization procedure cancelled after aspiration, case rate
S4022	Assisted oocyte fertilization, case rate
S4023	Donor egg cycle, incomplete, case rate
S4025	Donor services for in vitro fertilization (sperm or embryo), case rate
S4026	Procurement of donor sperm from sperm bank
S4027	Storage of previously frozen embryos
S4028	Microsurgical epididymal sperm aspiration

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Infertility and related diagnosis codesICD-10

N46.01-N46.9	Male infertility, code range
N73.6	Female pelvic peritoneal adhesions
N80.1-N80.9	Endometriosis code range
N97.1-N97.9	Female infertility, code range
N99.4	Postprocedural pelvic peritoneal adhesions

Testis drainage and diagnostic proceduresICD-10-PCS

0V993ZX, 0V994ZX, 0V9B3ZX, 0V9B4ZX, 0V9C3ZX, 0V9C4ZX	Surgical, drainage, testis, diagnostic, code by body part (right, left or bilateral) and approach (percutaneous, percutaneous endoscopic)
0V9B3ZZ, 0V9C3ZZ, 0V993ZZ	Surgical, drainage, testis, percutaneous, code by body part (right, left or bilateral) and approach

Testis excision and spermatic-cord drainageICD-10-PCS

0VB93ZX, 0VB94ZX, 0VBB3ZX, 0VBB4ZX, 0VBC3ZX, 0VBC4ZX	Surgical, excision, testis, diagnostic, code by body part (right, left or bilateral) and approach (percutaneous, percutaneous endoscopic)
0V9F0ZX, 0V9F3ZX, 0V9F4ZX, 0V9G0ZX, 0V9G3ZX, 0V9G4ZX, 0V9H0ZX, 0V9H3ZX, 0V9H4ZX	Surgical, drainage, spermatic cord, diagnostic, code by body part (right, left or bilateral) and approach (open, percutaneous, percutaneous endoscopic)

Epididymal, vas deferens, and spermatic-cord drainage or excisionICD-10-PCS

0V9J0ZX, 0V9J3ZX, 0V9J4ZX, 0V9K0ZX, 0V9K3ZX, 0V9K4ZX, 0V9L0ZX, 0V9L3ZX, 0V9L4ZX	Surgical, drainage, epididymis, diagnostic, code by body part (right, left or bilateral) and approach (open, percutaneous, percutaneous endoscopic)
0V9N0ZX, 0V9N3ZX, 0V9N4ZX, 0V9P0ZX, 0V9P3ZX, 0V9P4ZX, 0V9Q0ZX, 0V9Q3ZX, 0V9Q4ZX	Surgical, drainage, vas deferens, diagnostic, code by body part (right, left or bilateral) and approach (open, percutaneous, percutaneous endoscopic)
0VBF0ZX, 0VBF3ZX, 0VBF4ZX, 0VBG0ZX, 0VBG3ZX, 0VBG4ZX, 0VBH0ZX, 0VBH3ZX, 0VBH4ZX, 0VBJ0ZX, 0VBJ3ZX, 0VBJ4ZX, 0VBK0ZX, 0VBK3ZX, 0VBK4ZX, 0VBL0ZX, 0VBL3ZX, 0VBL4ZX	Surgical, excision, spermatic cord, diagnostic, and surgical excision of epididymis, by body part and approach

Male reproductive inspection and repair proceduresICD-10-PCS

0VBN0ZX, 0VBN3ZX, 0VBN4ZX, 0VBP0ZX, 0VBP3ZX, 0VBP4ZX, 0VBQ0ZX, 0VBQ3ZX, 0VBQ4ZX	Surgical, excision, vas deferens, diagnostic, by body part and approach
0VJM0ZZ, 0VJR0ZZ	Surgical inspection of epididymis and spermatic cord, open; surgical inspection of vas deferens, open
0VQJ0ZZ, 0VQJ3ZZ, 0VQJ4ZZ, 0VQK0ZZ, 0VQK3ZZ, 0VQK4ZZ, 0VQL0ZZ, 0VQL3ZZ, 0VQL4ZZ	Surgical repair of epididymis, by body part and approach
0VQN0ZZ, 0VQN3ZZ, 0VQN4ZZ, 0VQP0ZZ, 0VQP3ZZ, 0VQP4ZZ, 0VQQ0ZZ, 0VQQ3ZZ, 0VQQ4ZZ	Surgical repair of vas deferens, by body part and approach

Right vas deferens bypass proceduresICD-10-PCS

0V1N07J, 0V1N07K, 0V1N07N, 0V1N07P, 0V1N0JJ, 0V1N0JK, 0V1N0JN, 0V1N0JP, 0V1N0KJ, 0V1N0KK, 0V1N0KN, 0V1N0KP, 0V1N0ZJ, 0V1N0ZK, 0V1N0ZN, 0V1N0ZP	Surgical bypass, right vas deferens, open, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier
0V1N47J, 0V1N47K, 0V1N47N, 0V1N47P, 0V1N4JJ, 0V1N4JK, 0V1N4JN, 0V1N4JP, 0V1N4KJ, 0V1N4KK, 0V1N4KN, 0V1N4KP, 0V1N4ZJ, 0V1N4ZK, 0V1N4ZN, 0V1N4ZP	Surgical bypass, right vas deferens, percutaneous endoscopic, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier

Left vas deferens bypass proceduresICD-10-PCS

0V1P07J, 0V1P07N, 0V1P07P, 0V1P0JJ, 0V1P0JK, 0V1P0JN, 0V1P0JP, 0V1P0KJ, 0V1P0KK, 0V1P0KN, 0V1P0KP, 0V1P0ZJ, 0V1P0ZK, 0V1P0ZN, 0V1P0ZP	Surgical bypass, left vas deferens, open, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier
0V1P47J, 0V1P47K, 0V1P47N, 0V1P47P, 0V1P4JJ, 0V1P4JK, 0V1P4JN, 0V1P4JP, 0V1P4KJ, 0V1P4KK, 0V1P4KN, 0V1P4KP, 0V1P4ZJ, 0V1P4ZK, 0V1P4ZN, 0V1P4ZP	Surgical bypass, left vas deferens, percutaneous endoscopic, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier

Bilateral vas deferens bypass proceduresICD-10-PCS

0V1Q07J, 0V1Q07K, 0V1Q07N, 0V1Q07P, 0V1Q0JJ, 0V1Q0JK, 0V1Q0JN, 0V1Q0JP, 0V1Q0KJ, 0V1Q0KK, 0V1Q0KN, 0V1Q0KP, 0V1Q0ZJ, 0V1Q0ZK, 0V1Q0ZN, 0V1Q0ZP	Surgical bypass, bilateral vas deferens, open, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier
0V1Q47J, 0V1Q47K, 0V1Q47N, 0V1Q47P, 0V1Q4JJ, 0V1Q4JK, 0V1Q4JN, 0V1Q4JP, 0V1Q4KJ, 0V1Q4KK, 0V1Q4KN, 0V1Q4KP, 0V1Q4ZJ, 0V1Q4ZK, 0V1Q4ZN, 0V1Q4ZP	Surgical bypass, bilateral vas deferens, percutaneous endoscopic, with autologous tissue substitute, synthetic substitute, nonautologous tissue, or no device, by qualifier

Vas deferens device removal and epididymal drainageICD-10-PCS

0VPR0DZ, 0VPR3DZ, 0VPR4DZ, 0VPR7DZ, 0VPR8DZ	Surgical removal of vas deferens intraluminal device, by approach
0V9J00Z, 0V9J0ZZ, 0V9J30Z, 0V9J3ZZ, 0V9J40Z, 0V9J4ZZ, 0V9K00Z, 0V9K0ZZ, 0V9K30Z, 0V9K3ZZ, 0V9K40Z, 0V9K4ZZ, 0V9L00Z, 0V9L0ZZ, 0V9L30Z, 0V9L3ZZ, 0V9L40Z, 0V9L4ZZ	Surgical drainage of epididymis, by body part, approach, and drainage device or no device

Additional male and female reproductive-system proceduresICD-10-PCS

0VCJ0ZZ, 0VCJ3ZZ, 0VCJ4ZZ, 0VCK0ZZ, 0VCK3ZZ, 0VCK4ZZ, 0VCL0ZZ, 0VCL3ZZ, 0VCL4ZZ	Surgical extirpation of epididymis, by body part
0WQM0ZZ, 0WQM3ZZ, 0WQM4ZZ, 0WQMXZZ, 0WWM07Z, 0WWM0KZ, 0WWM37Z, 0WWM3KZ, 0WWM47Z, 0WWM4KZ	Surgical repair of male perineum, by approach and device
0U804ZZ, 0U814ZZ, 0U824ZZ	Surgical division of ovary, percutaneous endoscopic, by body part
3E0P3LZ, 3E0P7LZ, 3E0P3Q0, 3E0P7Q0, 3E0P3Q1, 3E0P7Q1	Administration and introduction into the female reproductive system of sperm or fertilized ovum, by approach and qualifier
0WQN0ZZ, 0WQN3ZZ, 0WQN4ZZ, 0WQNXZZ	Surgical repair of female perineum, by approach
8E0VX63	Ob-Gyn

Place of serviceRevenue

Reproductive Physician Office

Place of service associated with Ob-Gyn and reproductive physician office services

Surgical extirpation, epididymisICD-10

0V9L30Z	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0V9L3ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0V9L40Z	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0V9L4ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCJ0ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCJ3ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCJ4ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCK0ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCK3ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)
0VCK4ZZ	Surgical, extirpation, epididymis, code by body part (right, left or bilateral)

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Surgical repair, male perineumICD-10

0WQM0ZZ	Surgical, repair, male perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQM3ZZ	Surgical, repair, male perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQM4ZZ	Surgical, repair, male perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQMXZZ	Surgical, repair, male perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)

Surgical repair, male perineum, approach and deviceICD-10

0WWM07Z	Surgical, repair, male perineum, code by approach and device
0WWM0KZ	Surgical, repair, male perineum, code by approach and device
0WWM37Z	Surgical, repair, male perineum, code by approach and device
0WWM3KZ	Surgical, repair, male perineum, code by approach and device
0WWM47Z	Surgical, repair, male perineum, code by approach and device
0WWM4KZ	Surgical, repair, male perineum, code by approach and device

Surgical division, ovaryICD-10

0U804ZZ	Surgical, division, ovary, percutaneous endoscopic, code by body part (right, left or bilateral)
0U814ZZ	Surgical, division, ovary, percutaneous endoscopic, code by body part (right, left or bilateral)
0U824ZZ	Surgical, division, ovary, percutaneous endoscopic, code by body part (right, left or bilateral)

Introduction, female reproductive, spermICD-10

3E0P3LZ	Administration, physiological systems and anatomical regions, introduction, female reproductive, sperm, code by approach (percutaneous or via natural or artificial opening)
3E0P7LZ	Administration, physiological systems and anatomical regions, introduction, female reproductive, sperm, code by approach (percutaneous or via natural or artificial opening)

Introduction, female reproductive, fertilized ovumICD-10

3E0P3Q0	Administration, physiological systems and anatomical regions, introduction, female reproductive, fertilized ovum, code by approach and qualifier
3E0P7Q0	Administration, physiological systems and anatomical regions, introduction, female reproductive, fertilized ovum, code by approach and qualifier
3E0P3Q1	Administration, physiological systems and anatomical regions, introduction, female reproductive, fertilized ovum, code by approach and qualifier
3E0P7Q1	Administration, physiological systems and anatomical regions, introduction, female reproductive, fertilized ovum, code by approach and qualifier

Surgical repair, female perineumICD-10

0WQN0ZZ	Surgical, repair, female perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQN3ZZ	Surgical, repair, female perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQN4ZZ	Surgical, repair, female perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)
0WQNXZZ	Surgical, repair, female perineum, code by approach (open, percutaneous, percutaneous endoscopic or external)

Other procedure, male reproductive system, external, collection, spermICD-10

8E0VX63

Other procedure, male reproductive system, external, collection, sperm

Coverage Conditions and Denial Risks

Documentation Required

Apply Member-Specific Benefit Plan Controls

Verify member eligibility and apply the member-specific benefit plan, applicable state mandates, and related policies before determining coverage. The member-specific plan controls if it conflicts with this medical policy, and some plans specifically exclude cryopreservation or storage charges.

Coverage of infertility services varies by member-specific benefit plan and may be governed by state mandates.
Cryopreservation of mature oocytes and sperm is medically necessary only when the individual is post-pubertal, anticipated infertility is due to medical or surgical treatment such as gonadotoxic therapy or bilateral oophorectomy, and the anticipated infertility is not due to normal reproductive aging or non-illness-related sterilization.
Medically necessary techniques include blastocyst transfer, adult testicular-tissue cryopreservation for azoospermia when part of an intracytoplasmic sperm injection procedure, and ICSI for male-factor infertility.
Check the benefit plan description for contractual exclusions or limitations on cryopreservation and storage.

Denial Risk

Investigational Techniques

Do not represent the following reproductive techniques as covered under this policy; they are considered investigational. ICSI is investigational when performed without male-factor infertility.

Assisted hatching.
Co-culture of embryos.
Cryopreservation, storage, or thawing of testicular tissue in prepubertal boys.
Intracytoplasmic sperm injection in the absence of male-factor infertility.

Denial Risk

Excluded Cryopreservation Indications

Do not approve cryopreservation of mature oocytes or sperm when the anticipated infertility is attributable to normal reproductive aging or to sterilization services that were not performed to treat an illness, injury, or disease.

The individual must be post-pubertal.
Anticipated infertility must result from medical or surgical treatment, such as chemotherapy, radiation therapy, or bilateral oophorectomy.
All applicable medical-necessity criteria must be met.

Billing Rule

Check Contractual Limitations

Review the member contract or certificate of coverage for exclusions, eligibility restrictions, partner-coverage rules, and benefit caps before billing or authorizing assisted reproductive techniques.

Eligibility after a prior voluntary sterilization procedure, including vasectomy or tubal ligation, varies by contract; reversal coverage may also be limited.
Procedures performed on one partner may not be payable under the other partner's infertility benefits. Workup and diagnosis for a noncovered partner may likewise be excluded.
Cryopreservation and storage of embryos or sperm may be limited, particularly when sperm is preserved before voluntary sterilization or when there is no specific plan for insemination or embryo implantation.
Contracts may impose a dollar cap on infertility benefits. Determine whether the cap includes infertility workup and diagnosis, therapy, or both.
A vasectomy-related diagnosis may be recorded as male-factor infertility, but coverage remains subject to the applicable contract.

Terms and Abbreviations

Assisted reproductive technologies (ARTs)

DefinitionFertility treatments in which eggs or embryos are handled.

Common applicationAssisted reproductive technology commonly involves in vitro fertilization, in which retrieved oocytes are inseminated with sperm and the resulting embryo is transferred to the uterus or fallopian tubes.

Not includedAssisted insemination using sperm from a woman’s partner or a sperm donor is not included in this definition.

Infertility

DefinitionA condition that may be caused by female factors, male factors, combined male and female factors, or unknown causes.

Female factorsExamples include pelvic adhesions, ovarian dysfunction, endometriosis, and prior tubal ligation.

Male factorsExamples include abnormalities in sperm production, function, or transport and prior vasectomy.

Assisted hatching

DefinitionMechanical disruption of the zona pellucida surrounding the developing embryo.

PurposeThe technique is intended to facilitate escape of the developing embryo.

Proposed benefitAssisted hatching has been proposed as a way to improve implantation after IVF.

Assisted hatching

Clinical roleAn adjunctive technique used with IVF and evaluated against IVF without assisted hatching.

Reviewed approachesThe reviewed approaches included laser, chemical, and mechanical methods.

Evidence reviewedA Cochrane review identified 31 randomized controlled trials involving 5,728 participants.

Embryo co-culture

DefinitionA technique intended to improve embryo culture so that a greater proportion of embryos reach the blastocyst stage.

Intended outcomesThe intended outcomes include improved implantation and pregnancy rates.

Embryo numberIf implantation improves, fewer embryos could be transferred in each cycle, potentially decreasing multiple pregnancies.

Feeder cell layer

DefinitionA cell layer used in embryo co-culture to support embryo culture.

Human sourceFeeder cell layers may be derived from human reproductive tissues, including oviducts.

Other sourcesOther sources include fetal bovine uterine or oviduct cells, Vero cells, and bovine kidney cells.

Ovarian tissue cryopreservation

DefinitionCryopreservation of ovarian tissue or an entire ovary followed by transplantation.

TransplantationTransplantation may be autologous or heterotopic.

PurposeThe technique is intended to sustain reproductive function threatened by sterilizing procedures such as chemotherapy, radiotherapy, or surgery.

Vitrification

DefinitionA flash-freezing cryopreservation process.

ComparisonVitrification is faster than controlled-rate slow cooling.

CryoprotectantsVitrification requires a higher concentration of cryoprotectants.

Blastocyst-stage transfer

DefinitionEmbryo transfer performed at the blastocyst stage.

TimingTransfer generally occurs on day 5 or 6 after fertilization.

Compared with cleavage-stage transferBlastocyst-stage transfer occurs later than cleavage-stage transfer, which generally occurs on day 2 or 3.

Cleavage-stage transfer

DefinitionEarlier embryo transfer performed at the cleavage stage.

TimingTransfer generally occurs on day 2 or 3 after fertilization.

Compared with blastocyst-stage transferCleavage-stage transfer occurs before blastocyst-stage transfer, which generally occurs on day 5 or 6.

Male factor infertility (MFI)

DefinitionA condition in which insufficient sperm numbers, abnormal sperm morphology, or poor sperm motility prevent unassisted IVF.

Sperm quantityInsufficient sperm numbers may constitute male factor infertility.

Sperm qualityAbnormal morphology or poor motility may constitute male factor infertility.

Intracytoplasmic sperm injection (ICSI)

DefinitionA procedure used in IVF for male factor infertility in which sperm is injected into an oocyte.

IndicationICSI is used when sperm quantity, morphology, or motility precludes unassisted IVF.

Clinical settingThe therapy reviewed is IVF with ICSI.

Blastocyst-stage embryo transfer

DefinitionEmbryo transfer performed at the blastocyst stage rather than at the earlier cleavage stage.

Blastocyst timingBlastocyst-stage transfer generally occurs on day 5 or 6 after fertilization.

Evidence comparisonThe reviewed evidence compares outcomes between blastocyst-stage and cleavage-stage transfer strategies.

Testicular sperm extraction

DefinitionCollection of sperm from testicular tissue in men with azoospermia.

Timing of collectionExtraction may be performed during or after a diagnostic biopsy.

Use of collected spermSperm may be used immediately for ICSI, or tissue and/or sperm may be cryopreserved for later ICSI cycles.

Cryopreservation of testicular tissue

DefinitionPreservation by freezing of testicular tissue or isolated sperm for subsequent use.

Subsequent treatmentPreserved tissue or sperm may be used in later ICSI cycles.

Alternative specimensEither isolated sperm or the entire tissue sample may be cryopreserved.

Testicular sperm extraction

PopulationTesticular sperm extraction is performed in men with azoospermia.

Collection and useSperm is collected from testicular tissue and may be isolated immediately for ICSI.

Later useThe tissue may instead be cryopreserved for later sperm isolation and ICSI cycles.

Cryopreservation of testicular tissue

DefinitionFreezing of isolated sperm or testicular tissue for later use.

ThawingThe preserved sperm or tissue can be thawed for subsequent use.

Treatment contextThawed material may be used during a subsequent ICSI cycle.

Azoospermia

DefinitionAbsence of spermatozoa in the ejaculate.

Relevant populationThe adult population reviewed includes men with azoospermia.

Related procedureMen with azoospermia may undergo testicular sperm extraction.

NCT

AbbreviationNCT.

MeaningNational clinical trial identifier.

Use in the policyNCT appears with clinical-trial listings and trial identifiers.

NCT

AbbreviationNCT.

Expanded meaningNational clinical trial.

Policy exampleThe clinical-trial section uses NCT with trial identifiers such as NCT03764865 and NCT04616417.

M-A

AbbreviationM-A.

MeaningMeta-analysis.

Evidence useThe abbreviation identifies evidence that statistically combines results from multiple studies.

AbbreviationSR.

MeaningSystematic review.

Evidence useThe abbreviation identifies a structured review of the available evidence.