Title: Comparison of Microbial Abundance and Diversity in Uterine and Peritoneal Fluid in
Infertile Patients with or without Endometriosis
Version: 0 Date: 11 Nov 2023
Reviewer's report:
Summary of the Manuscript
The manuscript titled "Comparison of Microbial Abundance and Diversity in Uterine and
Peritoneal Fluid in Infertile Patients with or without Endometriosis" investigates the potential
differences in microbial communities between patients with endometriosis-related infertility
(ERI) and tubal obstruction-related infertility (TORI). Utilizing 16S rRNA sequencing, the
study aims to explore how microbial diversity in the reproductive tract might correlate with
infertility issues in these distinct patient groups. The research presents a comprehensive analysis
of microbial abundance and diversity in both uterine and peritoneal fluid, offering insights into
the potential role of the microbiota in the pathophysiology of infertility related to endometriosis.
Introduction
Clarification of Prevalence Data: The reported prevalence range for endometriosis in infertile
women (20% to 50%) is notably broad. I recommend refining these statistics with more specific
sources or providing a rationale for the observed variation to enhance the accuracy of the
introduction.
Detailed Exploration of Infertility Mechanisms in EMs: The manuscript briefly mentions various
factors contributing to infertility in EMs patients but lacks a comprehensive analysis of their
specific roles. An expanded discussion on how these factors, including pelvic adhesions and
ovarian cysts, contribute to infertility would enrich the paper's introductory section.
Elaboration on EMs and Reproductive Tract Dysbiosis: The link between endometriosis and
dysbiosis of the reproductive tract microbiota is introduced but not thoroughly explored. A
more detailed discussion on the potential mechanisms by which dysbiosis might influence the
pathophysiology of EMs or its associated infertility could provide valuable context.
Justification for Comparative Analysis: The rationale for comparing endometriosis-related
infertility (ERI) and tubal obstruction-related infertility (TORI) is not clearly articulated.
Clarifying the specific insights anticipated from this comparison would strengthen the
introduction's framing of the study.
Materials and Methods
Justification for Patient Selection and Grouping: The criteria for patient selection and grouping,
particularly the stages of EMs chosen for comparison, need clearer justification. Elaborating on
the clinical and pathological differences between these stages and how they might impact the
study's outcomes would be beneficial.
Rationale Behind Sampling Techniques: The manuscript would benefit from a more detailed
explanation of the chosen sampling techniques for uterine and peritoneal fluid. Addressing
how these methods might influence the results of microbial analysis is crucial for the reader's
understanding.
Choice of DNA Extraction and PCR Amplification Methods: Additional information regarding
the selection of primers and the rationale behind focusing on the V4-V5 region of the 16S rRNA
gene would be valuable. How does this choice affect the diversity and types of microbes that
are detected?
Results
Interpreting Microbial Diversity Data: The data presented on microbial abundance and diversity
require deeper interpretation within the context of EMs and infertility. An analysis that correlates
these microbial changes with the disease's pathophysiology would be highly informative.
Robustness of Statistical Analysis: It would be prudent to discuss the statistical power of your
study, considering the sample size. Are the findings robust enough to support the conclusions
drawn, especially when comparing between different groups?
Discussion
Clinical Implications of Microbial Changes: The discussion hints at a correlation between
microbial alterations and infertility in EMs but lacks depth. Expanding on how these
microbial changes translate into clinical symptoms or prognosis would significantly enhance
the discussion.
Literature Comparison: A more comprehensive comparison with existing literature would
strengthen the discussion. How do your findings align with or differ from previous research in
this field?
Addressing Potential Biases and Study Limitations: Discussing potential biases, such as
selection bias, and the limitations of your study is essential. Suggesting areas for future research
based on these limitations would be beneficial.
Conclusion
Expanding on Broader Implications: The conclusion would benefit from a discussion on
the broader implications of your findings for future research, clinical practice, or patient
management in the field of gynecology and reproductive health.
Recommendations for Future Research: Providing specific recommendations for future
research, such as investigating the direct impact of specific microbial changes on fertility or
exploring therapeutic interventions targeting the microbiota, would be valuable.
Overall Assessment: This manuscript provides insightful observations into the relationship
between endometriosis, reproductive tract microbiota, and infertility. However, it requires
a more detailed examination of the underlying mechanisms, comparative analyses, and
methodological clarity. Addressing these aspects will substantially enhance the paper's scientific
merit and impact in the field.