What are the treatment guidelines for singles (single embryo transfer)?

From the Guidelines

Singles treatment guidelines recommend Intrauterine Insemination (IUI) as the first-line treatment for unexplained infertility, mild male factor infertility, and same-sex female couples or single women using donor sperm, with a focus on minimizing multiple pregnancies and ovarian hyperstimulation syndrome (OHSS) 1.

Key Considerations

• IUI should be combined with ovarian stimulation (OS) to improve live birth rates in couples with unexplained infertility and men with a total motile sperm count (TMSC) above 10 million 1.
• The optimal number of inseminations per cycle is one, as there is insufficient evidence to support double IUI within the same cycle 1.
• At least three consecutive IUI cycles should be performed, with no clear maximum number of cycles recommended 1.
• Good practice points include screening for infectious agents and preventing multiple pregnancies by withholding IUI when more than two dominant follicles are present 1.

Treatment Approach

• IUI with OS is the most effective option for couples with unexplained infertility and men with a TMSC of >10 million and a prognosis of a pregnancy without assistance <30% within a year 1.
• The cost-effectiveness of IUI versus IVF/ICSI should be considered, with IUI being less costly above a pre-wash TMSC of 3 million 1.
• Large randomized trials are needed to confirm the cost-effectiveness of IUI in different infertility scenarios 1.

Patient Management

• Patients should be informed about the risks and benefits of IUI, including the potential for multiple pregnancies and OHSS 1.
• A standardized methodology for IUI should be used, taking into account evidence-based data on how to perform IUI 1.
• Bed rest after IUI is recommended for 10 to 15 minutes to optimize pregnancy rates 1.

From the Research

Singles Treatment Guidelines

• The treatment of herpes simplex, herpes zoster, and other viral infections has been transformed by guanosine nucleoside antivirals such as valacyclovir, acyclovir, and famciclovir 2.
• Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, and is also approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as for once daily dosing for suppressive therapy 2.
• In herpes zoster, valacyclovir is more effective than acyclovir and equally effective as famciclovir at hastening the healing of zoster-associated pain and PHN 2, 3.
• A comparative study found that valacyclovir treatment accelerated the resolution of zoster-associated pain in more patients compared to famciclovir, and offered significant benefit in terms of pain resolution and safety profile 3.
• The main focus of herpes zoster management is rapid recovery from VZV infection, as well as reduction and prevention of zoster-associated pain and postherpetic neuralgia, with antivirals such as acyclovir, valacyclovir, and famciclovir being essential in treatment 4, 5, 6.
• Antiviral therapy, including acyclovir, valacyclovir, and famciclovir, can be used to shorten the course and decrease the severity of herpesvirus infections, and may suppress the virus itself, thereby preventing future outbreaks 5, 6.