Reviewer’s report
Title: 
The social stigma of infertile women in Zhejiang province, China: A
questionnaire-based study
Version: 
0 
Date: 
30 Apr 2019
Reviewer's report:
1. Abstract: 
Background:The authors should consider either changing the heading to research
objectives or give some introductory information to make clear to the reader why
the problem was considered worth investigating. In addition to this, P.R.china
should be written in extended form. 
Method:Better to include design of the study, sampling method and data
collection process
Result: what numerical summary measures used to compute the total score of
stigma?
* The first sentences of this section contain two total stigmatization scores
66.39±21.96 and 2.13±0.81. What is the difference clear difference between
these scores?
* Better to include predictors of stigmatization identified by multiple stepwise
regression only. 
2. Main document 
Background: 
* Information in the background section mainly focus on the burden of infertility
and related consequences in developing countries specifically in Africa, and
doesn't clearly formulate the problem in the selected study setting/ area.
* Paragraph three line 1-5 is all about the measurement scales of stigma.This is
better to be included in the methods section specifically in the data collection
instrument/measurements sub section. 
Methods:
Study objects: Better to change the sub heading to study participants 
* How do the researchers account for generality(external validity)issues that
arise from use of convenience sampling to select participants?
* Educational status of women influence the way women perceive their health
issue (infertility) and how they deal with their health issues and this is even
evidenced by your study. As a result, not including women who didn't attend any
formal education/ didn't complete primary schools, a group that might even face
a higher burden of psychological stigma, might have its own influence on
validity of results due to potential systemic errors. How the researchers justify
this?
Research tools:
* The first sentences in general information sub heading should be rephrased. 
* Variables in the general information and diseases information questionnaire
should be exhaustively listed.
* It would be better to put the exact value of Cronbach's 
α
 coefficient for the
overall scale and each sub scales.
Research method and quality control tool:
* What do you mean by N1 nurses? Are they employees of the hospital where
the study was conducted?
Data analysis 
* Line two describing measurements x±s doesn't represent sample mean and
standard deviation. Better to check this in the whole document and make
corrections accordingly. 
* In addition to mentioning statistical analysis methods, the authors should
explain why and for what specific purpose these statistical tests were selected to
analyze data.Moreover,other statistics used to report findings such as median
should be mentioned in this section. 
Result 
* I suggest authors to summarize and report general information and disease
information questionnaire results in text before reporting results of inferential
statistics.
* In second line of ''stigma status and scores in each dimensions'' subheading,
the authors reported that the range of stigma score experienced by female
infertility patients was from 27to 135. This is surprising because it is similar to
the range of ISS score.
* The authors stated''the survey results showed that the total score of stigma in
this group of infertile patients was (66.39±21.96)''. The descriptive summary
measure used report this number should be mentioned.
* The fact that the authors prefer to compare the mean score of stigma with the
median(2.5) is ambiguous. Is there any scientific justifications why authors
prefer to compare ISS sub scale means with a median score?
* Titles of table1,2 and 3 should tell about place and time of the study. 
* Revise the label of table 1 column 2. What do you mean by points and what
they represent?
* Running and reporting results of post hock analysis for variables that
significantly affect stigma label will give additional information for readers to
identify where exactly the difference happened among groups.
Discussion: 
Generally, this section is well written except the fact that literature's
used to link and explain findings are very few.
* Provide citation in line four of status of stigmatization on female infertility
patients sub section.
* Most of points discussed in subsection of "advice on health care "seems a
recommendation that has to be done after giving a conclusion for the study.
Conclusion:Better to change the title to conclusion and recommendations.
Table 2: Adding frequencies for some variables like family income, work status,
family type, and payment status give a value lower than the sample size(254).
Check the exact numbers used for analysis and write it in front of each variable
accordingly.
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.
Yes
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 additional 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:
Acceptable
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 gain 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 future?
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
I agree to the open peer review policy of the journal. I understand that my name
will be included on my report to the authors and, if the manuscript is accepted
for publication, my named report including any attachments I upload will be
posted on the website along with the authors' responses. I agree for my report to
be made available under an Open Access Creative Commons CC-BY license
(
http://creativecommons.org/licenses/by/4.0/
). I understand that any comments
which I do not wish to be included in my named report can be included as
confidential comments to the editors, which will not be published.
I agree to the open peer review policy of the journal