Title: Association between tissue stress reaction and ACE2/TMPRSS2 expression in endometria
of reproductive aged women before and during Covid-19 pandemic
Version: 1 Date: 04 Apr 2023
Reviewer:  Hammad Ali Fadlalmola
Reviewer's report:
Title: The title is concise and accurately reflects the topic of the study. However, it could be
improved by adding a bit more detail to make it more informative. For example, including the
specific population studied and the focus on SARS-CoV-2 cell entry proteins would make it
more specific.
Abstract: The abstract provides a good overview of the study and its key findings. However, it
could be improved by providing more details on the methods used and the significance of the
results. Additionally, it does not mention the limitations of the study or the implications of the
findings, which would be important to include.
Introduction: The introduction provides a good overview of the background and rationale for
the study, including the relevance of SARS-CoV-2 to reproductive health. However, it could be
improved by providing more details on the specific research questions addressed in the study.
Additionally, while the introduction briefly mentions the limitations of previous studies, it could
be strengthened by providing more specific examples and explaining how the current study
addresses these limitations.
Methods: The methods section provides a detailed description of the sample collection,
laboratory procedures, and statistical analysis used in the study. However, it could be improved
by providing more details on the specific antibodies used for immunohistochemistry and how
the immune-reactive score was calculated. Additionally, it does not mention the potential
confounding variables that were controlled for in the analysis, which would be important to
include.
Results: The results section provides a clear summary of the study findings, including the lack
of co-expression between ACE2 and TMPRSS2 in endometrial tissue. However, it could be
improved by providing more details on the distribution of ACE2 and TMPRSS2 expression
across the different tissue compartments and how this compares to other studies. Additionally,
the section could be organized more clearly, perhaps by breaking down the results into sub-
sections based on the different analyses performed.
Discussion: The discussion section provides a good interpretation of the study findings and
their implications for reproductive health. However, it could be improved by discussing the
limitations of the study in more detail and providing suggestions for future research to address
these limitations. Additionally, the section could be strengthened by discussing how the findings
compare to previous studies and how they contribute to the overall understanding of SARS-
CoV-2 cell entry in the reproductive system.
Recommendations: The recommendations section provides important guidance for healthcare
providers and women in reproductive age regarding the implications of the study findings.
However, it could be improved by providing more specific advice on how to incorporate these
findings into clinical practice. Additionally, the section could benefit from a more nuanced
discussion of the potential risks and benefits of ART during the pandemic, and how these may
vary depending on individual circumstances.