Title: Review of Asherman Syndrome and Its Hysteroscopic Treatment Outcomes: Experience
in a Low-resource Setting
Version: 6 Date: 20 Dec 2023
Reviewer's report:
The findings and suggestions of this study are very meaningful,
However, there are still some suggestions for corrections:
1. Please confirm and modify the consistency of the previous and later descriptions. “There are
177 people who meet the conditions and complete the survey? “
Line 27:However, only 177 of the study participants completed the telephone survey transcript.
Line 25:Of these, 177 patients met the inclusion criteria and were included in the final analysis.
2. Please confirm and modify the consistency of the previous and later descriptions.
ABSTRACT Line 15 Result: The study participants' mean age was 31.4 years (range: 21-39
years) at the time of their presentation, and 32.3 years (range: 22-40 years) during their phone
interview.
Line 28:The mean ages both at the initial presentation and at telephone interview were 31±4.2
(range 21-39) and 32.3±4.2 (range 22-40) years, respectively.
3.P.9 Line 11-12  Please confirm the correctness of data and categories(Table 7)
1.5% (3.9%?) had just slightly improved, 17.6%(23.2%?) had hypomenorrhoea, 14.7% had
oligomenorrhea, and 1.5% had oligomenorrhea(oligomenorrhea repeat?  41.2% Amenorrhea?).
4. DISCUSSION: If there are comparisons citing the results of other studies, the data should
be presented specifically.
The intrauterine adhesion recurrence rate in our study was 36.2%, which was significant but still
within the range of instances that had been previously recorded [25-27, 46]. Compared to the
Japanese repor(Research results data ?)t [46], this figure was higher although less than that in
Taiwan(Research results data ?) [26].
5. conclusion :Early screening for TB” is mentioned in the article. Is it possible to provide
specific suggestions to increase the value of the article?
“Early screening, the design of a special algorithm to identify endometrial TB and a high index
of suspicion for Asherman syndrome are essential to reverse the disease states.”
6. The table and description should be able to echo each other and be easier for readers to
understand. Please refer to this for suggestions for correction.
(1)Table 3: 14(7.9) should be 14(6.9)?
Recurrent pregnancy loss 14(7.9)
(2)Table 2: Possible factors
Factors                                        n (%)
Unknown/no obvious factor 91(51.4)
Obvious factor 86(48.6)
Post abortal curettage 10(11.6)
Cesarean section 14(16.3)
Myomectomy 6(6.9)
Endometrial TB 42(48.8)
Recurrent pregnancy loss 14(16.3)
(3)Table 4,5,8 Whether to add a column “Subtotal”
(4)Table 6 and Table 7 Can it be merged?
Table 6: Relationship between preoperative Asherman syndrome severity and postoperative
menstrual patterns (adjusted Bonferroni p-value=0.0028)
Postoperative menstrual pattern Overall p.value
Preoperative disease severity Previous normal menses Achieved normal menses Slight
improvement Hypomenorrhoea Oligomenorrhea Amenorrhea
<0.001
Mild disease 13(52.0) 5(20.0) 0(0) 5(20.0) 2(8.0)  0(0)
Moderate disease 15(22.1) 10(14.7) 4(5.9) 19(27.9) 10(14.7) 10(14.7)
Severe disease 0(0) 11(13.1) 3(3.6) 17(20.2) 14(16.7) 39(46.4)
Subtotal 28(15.8) 26(14.7 7(4.0) 41(23.2) 26(14.7) 49(27.7)
7. P.9 Line 10 :Menstrual outcomes, “At the end of the study, 50% of the 68 women who started
the study with amenorrhea still had it” “50% of the 68 women” I Don’t know what the source
of the data is? Table 3 present amenorrhea 68(38.4%) women? but 50%(34 women) Where the
data is presented ? Please confirm or explain.
8.Please write the decimal points in the same way, before and after, and write them to the first
place. Please confirm them all again.
ABSTRACT  Line 15 Result: The study participants' mean age was 31.4 years (range: 21-39
years) at the time of their presentation, and 32.3 years (range: 22-40 years) during their phone
interview.
Result Line 30:The mean ages both at the initial presentation and at telephone interview were
31±4.2 (range 21-39)
At the end of the study, 50% of the 68 women
The response rate was 76%.
When the intrauterine adhesion was filmy, hard, and merely dense, the risks were 2.3%, 4%, and
29.9%, respectively. The highest rate of recurrence was observed in endometrial TB patients
(47.6%), followed by MVA (33.3%), myomectomy (33.3%), and cesarean birth (28.6%).
Hysteroscopic adhesiolysis was performed once for 9.6%, twice for 22%, and three times for
3.4% of the patients with recurrent intrauterine adhesions.
Table 8
Mild disease 13(52) 5(20) 0(0) 5(20) 2(8)  0(0)
Stage I disease 20(80) 5(20)
Table7