Title: The relationship between serum progesterone level on the day of HCG trigger in IVF/
ICSI cycles and oocyte maturation and embryo quality: A retrospective observational study
Version: 2 Date: 14 Nov 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors. Thank you for submitting your manuscript.
May I offer the following suggestions and comments:
A) In your introduction, the paragraph that begins with "The significance of progesterone
elevation on the day of HCG trigger in ART first garnered attention in 1991 " is too long and is
hard to follow. It also has a lot of repetitive ideas that could be omitted for brevity. Furthermore,
at the end of the paragraph you, a priori, discuss the limitations of your study. I suggest you
remove them and talk about them in the limitations section of the discussion
B) I also find it unusual to include a complete paragraph detailing how you organized your
manuscript. I would remover it and let the subsections speak for themselves. This can make your
background section more succint.
MATERIALS AND METHODS
C) I suggest you start this section with a clear sentence that describes what study design you
selected
D) I believe some of the paragraphs are "over-adorned" with language such as "The patient
selection process was rigorously designed, ensuring that a wide range of infertility etiologies
were considered. "
I would simply describe the methods, as these sentences can be distracting
E) Your "selection of patients" paragraph appears to be a summary of all the methods?  Why do
you discuss statistical analysis there. Please restructure this paragraph
F) In "This study retrospectively analyzed 496 women presenting with infertility at the Moloud
Infertility Treatment Centre, Ali Bin Abi Talib Hospital, Zahedan, Iran, over a span of three
years"  Please mention the years. Also, is the name of the fertility treatment center relevant to
the study objectives?
G) None of the authors affiliations is in this clinic. How did you obtain the data? Is this a private
clinic? if so, do any of the authors work there? Please disclose as a conflict of interest
H) why did you include 496 women? Did you perform a power calculation?
I) Sentences like "the carefully selected patient sample ensures that findings are robust for short-
term outcomes. Future studies are needed to explore the long-term clinical relevance." seem like
things that would go on a discussion or conclusion
J) There is no need to explain to the readers what a P-value is
RESULTS
K) They way you describe your results also seems to be over-adorned. Sentences like "This
comprehensive approach was taken to gain a deeper understanding of how these factors might
interact with serum progesterone levels on the day of HCG administration" seem out of place.
There is no need to justify each of the methods in the results. Please simply describe the results
L) All of the paragraph "By exploring these foundational variables, we aim to establish a robust
understanding of the broader influences in IVF outcomes. With this groundwork, we then focus
on the core objective of our study: analyzing the relationship between serum progesterone levels
on the day of HCG trigger and both oocyte maturation and embryo quality. This step allows us
to delve deeper into how progesterone levels impact critical aspects of IVF success." seems out
of place. Why is this in the results?
M) Tables should be self-explanatory. Table 1 should contain a description of what groups A
and B are, as well as group size.
N) Your main exposure of interest is serum progesterone level. therefore, you have desgined
this as a causal analysis. Please restructure table 1 so that the 2 groups are at the top, in columns,
so that you dont have to repeat "A" and "B' in each row
O) In "The statistical analysis supported that serum progesterone levels were not significantly
correlated with patient age (p=0.327)" Your analysis does not support this. Your analysis fails
to reject the null. But even then, I would simply say that no association was found
P)  In "This suggests that higher progesterone levels may positively influence the number of
oocytes retrieved, which could be important for improving IVF outcomes." Could it not be
reverse causality given that this is retrospective data? Idem for BMI
Q) Your table 3 is very confusing and hard to follow. Please restructure and clearly define.
R) In figure 1, your X axis is patient number? Why not simply use progesterone
S) You also define the method you used to divide intro groups after presenting the tables by
groups
T) You conclude "While the study found no significant relationship between progesterone levels
and certain variables like patient age, BMI, or the overall fertilization rate, the analysis revealed
a clear decline in M1 oocytes as progesterone levels exceeded the 1.54 ng/ml threshold. "
Confused about the first half of that conclusion, as they are not your study objectives. i don;t
think your retrospective study can categorically conclude the rest