Title: Fertility specialists’ views, behavior, and attitudes towards the use of endometrial
scratching in Italy
Version: 3 Date: 03 Oct 2022
Reviewer's report:
Thank you for the opportunity to review this manuscript which describes the results of a
clinician-survey and website review of use and attitudes towards endometrial scratching in Italy.
While the rationale for the survey is clear of possible interest, particularly in Italy, the survey
suffers from a number of limitations and the current manuscript should be improved upon,
particularly in terms of the language and writing style, to ensure the methods and results are
accurately conveyed.
1. The manuscript contains many grammatical errors, phrasing or use of terms that are not
easily understood, and the manuscript would therefore benefit from extensive copy editing. For
example
a. Abstract line 10 – what does it mean “before quantitatively and then qualitatively”
b. Abstract line 11 – “retain” does not make sense
c. Page 4 line 17 – “its rating” what does that mean?
2. Abstract – would be helpful to explain why ES not recommended in practice (because there
is evidence it doesn’t work)
3. Abstract - Results section should have the numbers in it (e.g. %)
4. Please reduce the explanation of the survey questions in the methods as this is available in
the supplied Table 2
5. Excluding entries because three answers were missing does not appear to be scientifically
sound, depending on what was missing. Could these be included and analysis re-performed?
The results also state that “All questionnaires resulted totally completed” – does this mean that
you didn’t need to exclude any studies for having missing data?
6. Results- how many survey invitations were sent? This is not clear in terms of calculating a
response rate
7. Table 2- please include the numbers not just the %
8. The discussion could discuss why clinicians believe endometrial scratching has higher
implantation rates but not live birth rates, which seems counterintuitive.
9. “Do you perform premedication before endometrial scratching” – premedication with what?
What does this mean?
10. The paper states that no personal data were recorded, but this is not true as you recorded the
names of the respondents – you must have to have included them as authors.
11. “An improved implantation rate (71.8%) was considered the greatest benefit of ES in clinical
practice, even if no clear benefit of the ES was reported in 23.1% of cases.” Should this be
reworded to say ““An improved implantation rate (71.8%) was considered the greatest benefit
of ES in clinical practice, even if clinicians did not believe there was clear benefit of ES in
23.1% of cases.”?
12. Table 3 – one of the clinics does only 4 IVF cycles per year? Is this a typo? In the whole
clinic they do 4 IVF cycles?
13. Table 3 “Treatments performed” make it clearer this is the number of centres doing IVF
(looks like the number of cycles done or something)
14. The methods state that qualitative analysis was done but there is no evidence of this in the
results? Where are the ‘themes’?
15. The second paragraph of the discussion repeats the results, which should be reduced/
removed.
16. The discussion and conclusion are both too long
Thank you for the opportunity to review this manuscript which describes the results of a
clinician-survey and website review of use and attitudes towards endometrial scratching in Italy.
While the rationale for the survey is clear of possible interest, particularly in Italy, the survey
suffers from a number of limitations and the current manuscript should be improved upon,
particularly in terms of the language and writing style, to ensure the methods and results are
accurately conveyed.
1. The manuscript contains many grammatical errors, phrasing or use of terms that are not
easily understood, and the manuscript would therefore benefit from extensive copy editing. For
example
a. Abstract line 10 – what does it mean “before quantitatively and then qualitatively”
b. Abstract line 11 – “retain” does not make sense
c. Page 4 line 17 – “its rating” what does that mean?
2. Abstract – would be helpful to explain why ES not recommended in practice (because there
is evidence it doesn’t work)
3. Abstract - Results section should have the numbers in it (e.g. %)
4. Please reduce the explanation of the survey questions in the methods as this is available in
the supplied Table 2
5. Excluding entries because three answers were missing does not appear to be scientifically
sound, depending on what was missing. Could these be included and analysis re-performed?
The results also state that “All questionnaires resulted totally completed” – does this mean that
you didn’t need to exclude any studies for having missing data?
6. Results- how many survey invitations were sent? This is not clear in terms of calculating a
response rate
7. Table 2- please include the numbers not just the %
8. The discussion could discuss why clinicians believe endometrial scratching has higher
implantation rates but not live birth rates, which seems counterintuitive.
9. “Do you perform premedication before endometrial scratching” – premedication with what?
What does this mean?
10. The paper states that no personal data were recorded, but this is not true as you recorded the
names of the respondents – you must have to have included them as authors.
11. “An improved implantation rate (71.8%) was considered the greatest benefit of ES in clinical
practice, even if no clear benefit of the ES was reported in 23.1% of cases.” Should this be
reworded to say ““An improved implantation rate (71.8%) was considered the greatest benefit
of ES in clinical practice, even if clinicians did not believe there was clear benefit of ES in
23.1% of cases.”?
12. Table 3 – one of the clinics does only 4 IVF cycles per year? Is this a typo? In the whole
clinic they do 4 IVF cycles?
13. Table 3 “Treatments performed” make it clearer this is the number of centres doing IVF
(looks like the number of cycles done or something)
14. The methods state that qualitative analysis was done but there is no evidence of this in the
results? Where are the ‘themes’?
15. The second paragraph of the discussion repeats the results, which should be reduced/
removed.
16. The discussion and conclusion are both too long