Iron-deficiency Anemia Associated with Peritoneal Dialysis and Non-Dialysis-Dependent (NDD) Chronic Kidney DiseaseĪs defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Note: If the less cost intravenous iron product does not have the labeled indication (see Appendix), then Aetna considers medically necessary another intravenous iron product that has the required labeled indication. Therefore, Aetna considers Feraheme (ferumoxytol injection) and Injectafer (ferric carboxymaltose injection) to be medically necessary only for members who have a contraindication, intolerance or ineffective response to the available equivalent alternative intravenous iron products: Ferrlecit (sodium ferric gluconate complex in sucrose injection), INFeD (iron dextran injection), and Venofer (iron sucrose injection) for the labeled indication (see Appendix). There is a lack of reliable evidence that Feraheme (ferumoxytol injection) and Injectafer (ferric carboxymaltose injection) are superior to the lower cost intravenous iron products: Ferrlecit (sodium ferric gluconate complex in sucrose injection), INFeD (iron dextran injection), and Venofer (iron sucrose injection). Feraheme (ferumoxytol injection) and Injectafer (ferric carboxymaltose injection) are more costly to Aetna than other intravenous iron products for certain indications. Again, these side effects should resolve without additional care after the cycle is over.Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background Referencesīrand Selection for Medically Necessary IndicationsĪs defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Additionally, the injection site could become sore, red, or slightly bruised. About a quarter to a third of patients on injectable FSH will experience side effects, including headaches, mood swings, insomnia, hot or cold flashes, breast tenderness, bloating, or mild fluid retention. These medications are commonly used during IVF, but can also be used during some IUI cycles. The medication protocol with the highest chance of side effects are injectable gonadotropins (FSH) such as Follistim and Gonal-F. Common side effects include hot flashes, headaches, and breast tenderness. In our physicians’ experience, patients who take letrozole are slightly less likely to experience side effects, but again, they are typically mild and resolve after treatment ends (typically about 5 days). Approximately 15% of patients who use Clomid will develop an ovarian cyst, but these cysts are benign and usually resolve on their own after treatment is over. Other less common side effects include bloating, nausea, breast tenderness, weight changes, headaches, blurry vision, and mood swings. According to clinical studies, the most common side effect is hot flashes, experienced by about 10% of patients. The side effects of Clomid are typically mild. An unmedicated IUI cycle has virtually no side effects the risk of infection from the IUI itself is about 1 in 10,000. The potential side effects of IUI or IVF depend primarily on the medication that’s prescribed, if any. Finally, the sperm sample is inserted into the uterus via a thin catheter, and fertilization is allowed to happen as it would during a natural cycle-the sperm swim toward the egg and, hopefully, find and penetrate it. The sample is “washed,” a term for the process in which healthy sperm is isolated from the remainder of the seminal fluid to increase chances of fertilization. ![]() The first step of the IUI is for a male partner or sperm donor to provide a semen sample. ![]() ![]() This monitoring leads up to the culmination of the cycle-the actual IUI, which typically happens on the day of ovulation (either just before or just after ovulation). Ovulation is when a mature egg breaks free from the ovary and begins its journey down the fallopian tubes, where it can be fertilized in an attempt at pregnancy. Then, for about 12–14 days, your doctor will use bloodwork and ultrasound to monitor your menstrual cycle, ensuring that an egg is maturing properly for ovulation. Like most fertility treatments, an IUI cycle begins with the first day of your period.
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