Reviewer ’s report  
 
Title: The impact of thyroid -stimulating hormone levels in euthyroid women on intrauterine 
insemination outcome  
 
Version: 1 Date: 18 Jan 2018  
 
Reviewer: Juan Jesús Fernández Alba  
 
Reviewer's report:  
 
Dear authors.  
 
 
The present work is interesting but to be published it must undergo a thorough revision process.  
 
1.- In the introduction, the justification for the study focuses on the impact that subclinical 
hypothyroidism has on perinatal outcomes. In addition, the aut hors report the lack of agreement 
on the TSH cut -off point to consider that there is a subclinical hypothyroidism. It is evident that 
the Guidelines of the American Thyroid Association for the Diagnosis and Management of 
Thyroid Disease During Pregnancy an d the Postpartum published in 2017 have not been taken 
into account.  
 
Currently, the cut -off point to consider that there is a subclinical hypothyroidism has gone from 
2.5 to 4 mIU / ml.  
 
It is necessary to rewrite the introduction including the current crit eria of the ATA.  
 
 
2. In the study period, the accepted cut -off point for subclinical hypothyroidism was 2.5 U / L.  
Therefore, we can understand that in the study group (TSH> = 2.5 U / L), if the woman became 
pregnant, she was diagnosed with subclinical hyp othyroidism (We do not know the level of fT4 
as it is exposed in the section of limitations of the study). The authors should clarify whether this 
group of pregnant women was treated with levothyroxine or not.  
 
 
3.- I understand that TSH was determined befo re initiating ovarian stimulation. However, this 
point must be clearly expressed in the text.  
 
 
4.- Authors should explain how they calculated the sample size. In the case that, as it seems, the 
authors included the sample universe, it is necessary to clari fy the power of the study, 
specifically in the multivariate logistic regression analysis.  
5.- In the section of methods, the authors include BMI as an independent variable of multiple 
logistic regression. However, this variable is not included in the resu lts section. It is necessary to 
clarify why this variable was eliminated or include its result.  
6.- The authors state that 38 pregnancies were achieved. However, only the perinatal results of 
27 are reflected. It is necessary to explain what happened in t he 11 cases in which the gestational 
period was not completed. It is very important to clarify how many reproductive losses occurred 
in each group by specifying the number of miscarriages of the first trimester, late abortions and 
intrauterine fetal deaths  were recorded.  
 
 
7. In the discussion, the authors state that the American Thyroid Association believes that 
preconception point cut and the first trimester of pregnancy to diagnose and treat subclinical 
hypothyroidism is set to 2.5 IU / L. This statement  is not updated according to the latest ATA 
guideline of 2017 that sets the cut -off point at 4 U / L. The authors must update this aspect.  
 
 
8.- It would be interesting to include in the discussion a paragraph in which it is reflected that the 
results found by the authors are relevant since they endorse the recommendation of the 2017 
ATA.  
 
 
 
 
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 sh own?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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 manuscr ipt: 
 
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, fund ing, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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, w rite 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare th at I have no competing interests.  
 
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