Title: Psycho-social experience of oocyte recipient women: a qualitative study
Version: 1 Date: 07 Sep 2021
Reviewer's report:
The study has many merits in its qualitative analysis, specifically in providing direct and
powerful quotations from the participants on the difficult psychological issues faced when one
receives donated oocytes. This is also a unique study in that it analyzes a specific population of
women in Iran, and does well to understand their particular viewpoints on the issue. I commend
the authors on their unique study design, and this type of qualitative research is definitely needed
to advance the understanding of physicians working in third party reproduction. However, in its
present form it is not ready for publication for three main reasons.
1. It would improve the quality of the study to analyze their data on a further level. At the
moment, they only report on the psycho-social stressors found, and do not make any conclusions
as to which themes are most prevalent, and for what reasons. For example, their paper would be
strengthened if they provided an analysis of whether or not demographic characteristics (age,
education level, job, and the rest of the categories in table 1) were associated with any specific
sub-categories of the psychosocial experiences expressed in the interviews. Additionally, while
a qualitative study, it would still be excellent information to report the percentage of interviewees
that expressed thoughts in each sub-category (for example, 75% of the participants expressed
feelings of denial), and then to make hypotheses in their discussion as to why certain feelings
were more or less prevalent in their population.
2. The methods were too vague, and thus this study would be very difficult to repeat. First,
they do not describe who was performing these psycho-social interviews. Was the researcher/
interviewer a psychologist or psychiatrist, an REI nurse or physician, or someone else entirely?
Similarly, while the interviews lasted up to 60-90 minutes, the authors only provide 2 very broad
questions that they asked their participants ("Please tell the story of using donated oocytes in
the treatment of your infertility" and "what issues and problems did you encounter with regard
to this treatment method?). They then go on to state that "exploratory questions were then used
to achieve more clarity," however they do not provide any further information on what those
questions were. It would have likely been better to use a more standardized interview framework
with multiple different questions for each participant, thus ensuring that each interviewee had
the ability to address each of the specific psycho-social parameters in question.
3. The paper has extensive grammatical issues, as well as problems with run-on sentences that
make it difficult to read and not ready for publication. It needs extensive grammatical revisions
to be easily read in plain English. For example, the following sentence has multiple errors
that make it difficult to understand: "Using donated oocyte has brought about many successes,
but it can face recipient women with considerable psychological challenges and the aim of
this study was to obtain comprehensive information about the experiences of recipient oocyte
donation." Sentences like this were unfortunately common in the manuscript.  Also the word-
choice throughout the paper could be improved for the quality of a scientific publication. For
example they state in their conclusion "the recognition of these reactions in the treatment process
helps a lot to the treatment team," where instead they could say it "helps immensely" or "helps
tremendously."