Reviewer ’s report  
 
Title: Preferred problem solving and decision -making role in fertility treatment among women 
following an unsuccessful in vitro fertilization cycle  
   
Version: 0 Date: 14 May 2019  
 
Reviewer: Lone Schmidt  
 
Reviewer's report:  
Review  
BMWH-D-19-00141  
 
This is an interesting and important, cross -sectional survey on decision -making among Chinese 
women undergoing IVF treatment. Fertility treatment is a special case as the patient is (most 
often) a couple and not only one individual. Hence, t he decision -making processes involves three 
people (the couple and the fertility specialist/medical doctor) and hence, the decision -making 
process are different from when treating people in the health care system for other diseases than 
infertility. Few st udies have explored decision -making among fertility patients.  
The manuscript is well -written and the study and the results are clearly presented.  
 
I have the following suggestions/reflections:  
 
Abstract  
a. Please, state specifically HOW preference for passive role was associated with marital 
satisfaction and anxiety (see similar comment below/Results).  
 
b. Why is used the term "subfertility type" instead of infertility type? Suggest to keep it simple 
and only use "infertility" (subfertility is not defined in the text and it is not clear how it differs 
from infertility).  
 
 
Background  
a. Suggest to add a paragraph in the Introduction section/Method section describing the 
context/setting for this study. In th e Discussion section is presented very relevant information 
regarding family formation/child bearing, paternal bloodline etc. in a Chinese culture (see 
paragraphs on p. 19 and p. 23). However, as a reader I would prefer to have the Setting clearly 
presente d before reading the study results.  
 
b. P. 5 line 30 -52/Line 87 -92. Probably beneficial to add a reference on women and men's reason 
for seeking fertility treatment (some gender differences)?; e.g., Schmidt et al., Human 
Reproduction 2003;18:628 -37. 
 
c. P. 7 line 22 -42/Line 120 -126. Suggest to include only the figure and not this text. The figure 
provides an excellent overview; from the text (line 120 -126) it is difficult for the reader to get the 
overview.   
 
Methods  
a. P. 11 line 45 - p. 12 line 17/Line 20 2-213.  As far as I can see, primary and secondary 
infertility are not defined in this section but included in Table 1. Usually primary infertility is the 
non-achievement of a first pregnancy while secondary infertility indicates the women had 
previously o btained a pregnancy (irrespective of the outcome - e.g, birth/pregnancy loss/ectopic 
pregnancy). I am not sure how secondary infertility is used in Table 1. As in the Discussion I get 
the impression that secondary infertility is related only to previous un successful pregnancy 
outcome and not to live birth. Please, clarify.  
 
Results  
Please, be sure throughout the text always to state specifically HOW the associations between 
variables were. E.g., p. 16 line 39 -42/line 296 -297 is stated "… preference for Pass ive (versus 
Shared) was related to higher husband's age, marital satisfaction and anxiety". Please, make it 
100% clear for the reader - was the Passive preference associated with higher or lower marital 
satisfaction and higher/lower anxiety levels, respect ively?  
 
 
Discussion  
a. P. 18 line 20 -39/line 328 -333. It is discussed why passivity was associated with secondary 
infertility and mentioned that women with secondary infertility might have had previous 
pregnancy loss (i.e., complicated reproductive event).  However, from Table 1 is stated that out of 
the 115 women with secondary infertility 38 women had previously delivered one or more 
children. Hence, the group of secondary infertile women have very different prior experiences 
when it comes to reproductive outcome. I suggest this fact to be included in the discussion of this 
point (association between passivity and secondary infertility).  
 
b. P. 21 line 20/383. Here it is stated "the experience of infertile women". I suggest instead to 
state of women underg oing ART treatment (or IVF treatment). A general "rule" is not to 
characterize people with their diagnosis and further, at number of the women in this study are not 
infertile themselves but have a partner with male factor infertility. Same comment goes for  e.g, 
in Table 2 "Canadian infertile women".  
 
c. P. 23 line 49 - p. 24 line 4/Line 429 -433. A number of survey and interview studies among men 
in fertility treatment have been conducted providing men's perspective on treatment, their desire 
for fatherhood e tc. Some of these studies could be referred to. Search in Pubmed e.g., for 
publications by Karin Hammarberg; Gitte Lindved Petersen; Randi Sylvest; Alice Toft 
Mikkelsen.   
 
Figure, table, references  
a. All references mentioned in Figure 1 are missing in the reference list.  
 
b. A careful proof reading is necessary - a few inconsistencies exists.  E.g., missing full stop after 
"Educ" (ref. Vogel et al.); ref Olafsdottir et al. should not be "Healthc"; D eber et al. - is it correct 
to abbreviate to "Heal"?   
 
c. Suggest to delete the decimal in all percentages in tables and text. Including one decimal 
indicate a higher precision than what is possible in this sample. Further, percentages without the 
decimal  is much easier to read and no information is lost by not having the decimal included.  
 
Are the methods appropriate and well described?  
If not, please spec ify 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
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 specify what aspects req uire 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 manuscript:  
 
Acceptable  
  
Declaration of competin g interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially fr om 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, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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