Title: Effects of hysteroscopic septum incision versus expectant management on IVF outcomes
in women with complete septate uterus: A retrospective study
Version: 1 Date: 24 Jan 2024
Reviewer's report:
In this study, the authors aimed to evaluate the impact of hysteroscopic septum incision on IVF
outcomes in patients with the complete uterine septum and without recurrent pregnancy loss
history. The main finding was that pregnancy outcomes were similar between patients having
hysteroscopic septum resection before IVF and patients undergoing expectant management.
Comments;
• Abstract:
Grammar errors should be re-checked and corrected.
In the abstract section, the actual numbers of the non-significant variables for secondary outcome
measures are unnecessary.
All keywords should be added from MeSH (Medical Subject Headings).
• Introduction:
Language and grammar should be re-checked and corrected.
The first paragraph is long and should be divided into two separate sections.
The second and third paragraphs should be combined and shortened.
• Methods:
The ethical declaration part should be added after the patient recruitment part.
A reference number should be added for ASRM diagnostic criteria of uterine malformations.
Controlled ovarian hyperstimulation (COH) is not an appropriate term. Ovarian stimulation (OS)
has recently been accepted as a favorable term.
In flexible GnRH antagonist protocol, GnRH antagonist is generally used when the leading
follicle reaches # 14 mm. Are you sure about 10 mm?
Which protocol was used for ovulatory patients in frozen-thawed cycles?
Definitions of live birth and miscarriage are incompatible with each other regarding gestational
age.
Luteal phase support (LPS) is an essential approach for IVF cycles. Drug, doses, and duration
of the used drug should be described for LPS.
The comparison of the mean of embryo quality between groups and methods (with reference)
used to evaluate quality should be reported.
The statistical analysis part is poor and could be better. Describe normality tests such as visual
(histograms, probability plots) and analytical methods (Kolmogorov-Smirnov test to determine
whether variables were normally distributed or not. Parametric and non-parametric tests should
be used after this analysis. The statistical approach used for the model assessment in multivariate
logistic regression analysis should be added (for example, Hosmer-Lemeshow goodness of fit
statistics).
Determine categorical covariates for logistic regression analysis in this section, if any.
How were data presented? (Mean, median, or percentages). It should be added to the statistical
analysis section.
• Results:
Data abbreviations and how the data was presented (Mean, median, or percentages) should be
added below the tables.
The number of transferred embryos (Mean or median values) should be added in Table 2 for
each group.
The results of the table 1 should be shortened. Details of secondary infertility are unnecessary
for both groups.
The authors said AMH levels were comparable but as shown in Table 2, AMH levels were
significantly higher in the surgical group (p=0.029).
There are repetitive sentences and information in the second paragraph representing the baseline
characteristics part (Lines 9-12). Besides this, these results have already been shown in Table
2. Details of non-significant variables are unnecessary.
In Table 3, the number of ongoing pregnancies should be 25, not 28. As mentioned by the
authors, of 36 pregnancies, 8 were miscarriages, and 3 were ectopic pregnancies. So, ongoing
pregnancy rates should be different in the expectant management group.
The number of pregnancies is unnecessary other than ectopic pregnancies. These results have
already been presented in Table 3 (Lines 5-13).
Page 14, Line 8: The number of live births should be 15, as presented in Table 3.
• Discussion:
Language and grammar should be re-checked and corrected.
For the first paragraph, the number of patients should be removed and this paragraph should
be shortened.
The fourth paragraph, including preterm delivery information, is unnecessary because there are
no preterm deliveries in this cohort.