Reviewer ’s report  
 
Title: The prevalence  of primary ovarian insufficiency in Sweden; a national register study.  
 
Version: 0 Date: 28 Nov 2017  
 
Reviewer: Mindy S Christianson  
 
Reviewer's report:  
 
In the manuscript entitled "The prevalence of primary ovarian insufficiency in Sweden; a 
national register study," the authors evaluate the prevalence of primary ovarian insufficiency 
(POI) in Sweden among women born between 1973 and 1993.  Overall, this is an important 
paper the provides further elucidation regarding the prevalence of POI.  Overall, recommend 
publication pending revisions based on comments and suggestions below:  
 
1.  Introduction:  Recommend including a bit more background information regarding the 
diagnosis of POI.  For example, the Nelson NEJM review article could be used as a reference to 
provide additional background on the current diagnosis of POI as well as the etiologies.  It would 
also be beneficial to include why this is an important condition to diagnose.   
 
2.  Methods:  Was there a way to extract patient a ge for the diagnoses?  Patient age would be of 
interest.  
 
3.  Methods:  Some estrogen formulations ( ie estradiol and conjugated estrogens) are prescribed 
for patients undergoing assisted reproductive technology (ART).  Could prescriptions for 
hormone ther apy as an adjunct for ART account for a possible percentage of the presumed POI 
diagnoses?  I am not familiar with ART in Sweden but in the US estradiol is often prescribed for 
poor responders prior to ART and to prepare the uterine lining prior to frozen embryo transfer.  It 
is important for the authors to look into this possibility and comment accordingly.   
 
3.  Results:  Is it possible to provide a mean patient age?   
 
4.  Discussion:  Please include in the paragraph on strengths and limitations the pos sibility of 
over-diagnosis of POI from hormone therapy use for fertility treatment.  
 
5.  Discussion:  The last sentence on infertility and POI is a bit inaccurate as patients with POI 
are generally not candidates for ART unless they proceed with donor egg.  
 
6.  Overall:  The manuscript would benefit from English editing prior to publication.  
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an addition al statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gai n or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the fu ture?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
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