Reviewer's report 
 Surveying of Relationship between Anxiety, Depression and Duration of Infertility Title: 
 1  8 December 2003 Version: Date: 
 Hidehiko Matsubayashi Reviewer: 
Reviewer's report: 
General 
This is an interesting observation in the point of infertile Iranian women, because many readers 
don?t know about Iranian well. Unfortunately, it is difficult to understand their results, because the Tables and Results section are not matched well and it is not clear which groups are compared. 
Secondarily, the classification of depression and anxiety stage (normal, mild, moderate, and severe) 
is very important in this study, but its definition is not clear. A more detailed description is necessary 
for Beck Depression Inventory and Cattle questionnaires. Since those 2 inventories are originally 
written in English, it is necessary to clarify which language (probably Iranian) was used and how 
those are standardized. Method section needs more detailed description. 
Thirdly, since the number of references is too small, their discussion is inadequate. The results of 
the study and other study are just listed in the Discussion. If authors discuss some possibilities to explain their results compared with other studies (countries) from the cultural point of view, this paper will be attractive. 
Discretionary Revisions (which the author can choose to ignore) 
1) To add special characteristics of Iranian would be much better. 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
1) Do not use Arabic numerals in the top of the sentences (c.f., page 4, lines 2, 6, 20). Those should 
be spelled out. 
2) Page 4, line 1; ?Results and Discussion? should be ?Results?. 3) Page 2, line 3; ?Medicine? is not appropriate. ?Previous reports? would be much better. 4) Page 2, lines 5-6; It would be ?effect on psychologic factors such as anxiety and/or depression, 
resulting in reduction of physiological functions?. 
5) Page 2, line 6; It would be ?Infertility sometimes accompanied?. 6) Page 2, line 11; BDI should be spelled out, because this is the first appearance in the text except for abstract. 
7) Page 2, lines 16-18; This sentence needs correction. Using ?Non? but ?no? is not appropriate. 
8) Page 4, line 6 and page 6, line 12; homemakers would be housewives. 9) Table 1; spouse job should be spouse?s job. 10) Table 2; Male cause, female cause, both cause, and unknown cause is much better than male, 
female, both, and unknown. 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
This is an interesting observation in the point of infertile Iranian women, because many readers don?t know about Iranian well. Unfortunately, it is difficult to understand their results, because the Tables and Results section are not matched well and it is not clear which groups are compared. 
Secondarily, the classification of depression and anxiety stage (normal, mild, moderate, and severe) 
is very important in this study, but its definition is not clear. A more detailed description is necessary 
for Beck Depression Inventory and Cattle questionnaires. Since those 2 inventories are originally 
written in English, it is necessary to clarify which language (probably Iranian) was used and how 
those are standardized. Method section needs more detailed description. 
Thirdly, since the number of references is too small, their discussion is inadequate. The results of the study and other study are just listed in the Discussion. If authors discuss some possibilities to 
explain their results compared with other studies (countries) from the cultural point of view, this 
paper will be attractive. If all of these are improved and authors make the suggested corrections, this will be an interesting paper. 
1) Results and Tables are quite confusing. Tables represent just a raw data and it is difficult to 
understand the results. Table should be expressed clearly and understandable with itself. For example, it would be much better that the rate of Tables 2 and 3 might be expressed percentage in 
each group (See below). Frequency against all women is not important. All Results and Tables must 
be reconstructed. In Table 1, Demographic frequency of your study is not so important. The 
important point is depression or anxiety scores of each group and whether it is statistically different. 
2) How to calculate P value between which group is not clear. To clarify which groups are compared, 
it is necessary to separate groups and to show P value in the Table. 
3) Too much word ?relationship? is used in this manuscript. Relationship includes both negative and 
positive correlation. It should be clarified and clearly described. 
4) How to classify the stage of anxiety or depression should be addressed. Which cutoff points were 
used and why such cutoffs were used? 
5) Page 3, line 14; How to choose 370 women randomly? What is their background (c.f., age, 
duration of infertility, infertility cause, routine work up, treatment) 6) Page 3, line 18; Statistical analysis needs more information. Which groups were compared with 
which methods? How did you consider it as statistically significance? 
7) Page 3, line 14; Who (Dr., Ns., or psychologist) told the objectives to patients and how? 
8) Page 6, line 1; Why your study showed such high depression and anxiety level in comparison with 
other studies? You need more references in comparison and more explanation. 
9) Page 6, lines 6-7; Which study did you indicated? If reference #8, ?this? would be ?that?. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of limited interest Level of interest: 
 Not suitable for publication unless extensively edited Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None