Reviewer's report 
 The effect of duration and cause of infertility on anxiety and depression in infertile women Title: 
 5  19 June 2004 Version: Date: 
 Hidehiko Matsubayashi Reviewer: 
Reviewer's report: 
General 
This revised manuscript is much better than the previous one, but some points, that the reviewer 
pointed out, have not been corrected yet. Logic-flow is still poor to understand in INTRODUCTION and DISCUSSION. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 1) Data for age and duration of infertility were missing. The authors should put the data of both 
results in the RESULTS section. Additional table or figure will be necessary for both. If the authors 
don?t want to add those data, they should omit page 10, line 13 - page 11, line 2, and page 11, line 16 ? page 12, line 13. 2) Statistical methods should be on the table. 
Table 2; ?P-value*? in the table, ?*Chi-square for 2 x 9 table? below the table. 
Table 4; ?P-value*? in the table, ?*unpaired t-test? below the table. 3) The Introduction and discussion sections are important, but still poor to understand. Each paragraph should contain the same category (topic). Between different paragraphs, logical 
relationship should be necessary. Finally, the conclusion that the authors want to draw should be 
discussed naturally. 4) Why your study showed such high depression and anxiety level in comparison with other studies? The authors should explain more detailed points of social, cultural, and economical background in 
Iran; how long does it take to divorce without children, how often does the divorce occur, can man 
marry with more than 1 wives? (This is what the reviewer pointed out before.) 
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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) Page 2, line 9; ?husband? would be ?husbands?. 2) Page 2, line 13; need comma between ?duration of infertility? and ?education level?. 
3) Page 2, line 15; ?and? would be ?or?. 
4) Page 2, line 18; ?serious? is not appropriate. 5) Page 2, line 20; ?life quality? would be ?quality of life?. 6) Page 3, line 3; ?That? would be omitted. (This is what the reviewer pointed out before.) 
7) Page 3, lines 5-7; Unfortunately, many obstetricians and gynecologists did not think that the 
psychogenic infertility is true. Very small amount of researchers like Domar (reference #2) have 
published several manuscripts to say such topic. It is almost 10 years. Therefore, this sentence is not 
appropriate. For instance, that would be changed to ?Recently, psychogenic cause became one of 
the topic in infertility, as diagnostic abilities improved.? (This is what the reviewer pointed out 
before.) 8) Page 3, line 8; ?drawn? would be ?paid?. 9) Page 3, line 10; need comma between ?anxiety and frustration?. 
10) Page 3, line 13; ?anxiety reduction? would be ?reduction of anxiety?. 
11) Page 3, line 15; ?fertility? would be ?infertility?. 
12) Page 3, line 16; ?between depression and infertility and depression could play? would be 
?between infertility and depression, which could play?. 
13) Page 3, line 18; This sentence is just the repeat of the previous sentence. Therefore, this could be omitted and add the reference #9 to the reference #8. (Page 3, line 17; pathogenesis of infertility (8,9).) 
14) Page 3, lines 19,20; This cannot be understood. ?emotional tensions. Also it is effective in 
causing: anxiety? would be changed to ?emotional tensions such as anxiety?. 15) Page 4, line 11; What is the ?same?? This should be clarified. 16) Page 4, lines 13,14; It would be better to use the same paragraph. (Don?t change the line.) 
17) Page 4, line18; ?not any? would be ?no?. 
18) Page 4, line 22 and page 5, line 1; It would be better to separate sentences. ?third year of infertility. After six years?. 19) Page 5, line 7; ?or/and? would be ?and/or?. 
20) Page 5, line 8; ?anxiety, depression? would be ?anxiety/depression?. 
21) Page 5, lines 19-22; ?midluteal phase and diagnosis endometriosis? would be ?midluteal phase, diagnosis of endometriosis?. ?based on HSG and cervical? would be ?based on HSG, and cervical factor?. Need comma before ?then they were visited by a psychologist?. The repeat of ?based on? 
is not good. It would be better to use other words such as ?diagnosed by? or ?evaluated by?. 
22) Page 6, line 4; BDI; You should use reference number in the text and write down the published book name and authors in the section of REFERENCES. 23) Page 6, lines 5,6; It would be better to use the same paragraph. (Don?t change the line.) 
24) Page 6, line 18; Cattle; You should use reference number in the text and write down the 
published book name and authors in the section of REFERENCES. 25) Page 7, line 3; ?based on previous studies (18)? is unclear. Need explanation, or omit it. 26) Page 7, lines 14-18; This paragraph should be in the METHODS section. 
27) Page 8, line 1; ?x2? would be ?c2?. 
28) Page 8, line 8; ?about? would be omitted. 29) Page 8, line 8; ?severe? would be omitted. 30) Page 8, line 17; ?T-test? would be ?t-test?. 
31) Page 9, line 11; ?oddens? would be ?Oddens?. 
32) Page 10, line 4; ?tender? is very hard to understand. It would be changed to other words. 33) Page 10, line 5; remove comma between ?effectively? and ?vital factor?. 34) Page 10, line 6; ?second marriage fertile? would be ? second marriage with fertile partner?. 
35) Page 10, line 8; ??? would be ?etc.?. 
36) Page 10, line 14; ?According to? would be ?From? or ?In?. 37) Page 11, line 3; ? causes weaker responses to? would be ?may reduce stress from?. 38) Page 11, line 4; ?According to? would be ?From? or ?In?. 
39) Page 11, line 6; ?decrease? would be ?decreases?. 
40) Page 11, line 9; ?factors,? would be ?factors.?. 41) Page 11, line 12; ?men(? would be ?men?. 42) Page 11, line 15; Need references for ?other studies?. 
43) Page 12, line 5; ?4th through 6th? would be ?4-6?. 
44) Page 12, line 6; ?will be? should be omitted. 45) Page 12, lines 7-9; ?Therefore ??.become worse.? should be omitted. 46) Page 12, lines 13-14; It would be better to use the same paragraph. (Don?t change the line.) 
47) Page 12, lines 15-16; ?surge in depression, anxiety and could? would be ?surge in depression 
and/or anxiety, which could?. 48) Page 12, lines 17-19; These are ACKNOWLEDGEMENTS. It would be better to separate from DISCUSSION. 
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Discretionary Revisions (which the author can choose to ignore) NONE 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Not suitable for publication unless extensively edited Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None