Title: The relationship between serum progesterone level on the day of HCG trigger in IVF/
ICSI cycles and oocyte maturation and embryo quality: A retrospective observational study
Version: 5 Date: 04 Dec 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors - Thank you for submitting your re-reviewed manuscript.
May I offer the following comments and suggestions:
INTRODUCITON
A) Overall, I think this sections is adequate, except for the final sentence:
"A key aspect of this study is the identification of a progesterone cutoff level, 1.54 ng/ml,
beyond which oocyte quality begins to decline. This finding has significant clinical implications,
providing a potential marker for tailoring ovarian stimulation protocols. The study also considers
how these results align with previous research, emphasizing both the strengths and limitations
of the findings, and suggesting directions for future research to enhance our understanding of
progesterone’s role in reproductive medicine."
The 1.54 is one of your results, please do not include in your introduction. Better, describe that
you seek to evaluate a cut-off as a secondary objective , and why this is important (which you
already did)
MATERIALS AND METHODS
B) There is still some work needed in the materials and methods section.
I would start the 'selection of patients' section at "This study retrospectively analyzed 496....".
The preceding sentence could be shortened, as terms as "adhering to strict inclusion and
exclusion criteria." is mentioned twice. Instead, readers will simply read your inclusion and
exclusion criteria, and discuss in the discussion how strict they are and how this impacts your
results
C) Please briefly explain the reasons for your exclusions
D) Although it has improved significantly, some sentences are still overadorned, such as "We
employed Statistical Package for the Social Sciences (SPSS), version 22, to perform a range
of statistical analyses, ensuring that our approach was tailored to the key variables under
investigation, such as serum progesterone levels, oocyte maturity, and embryo quality. "
This could be re-written to simple "We performed all statistical analysis using Statistical Package
for the Social Sciences (SPSS), version 22"
Also, I notice that you switch between active "We employed" and passive "The data were
inputted voice. I suggest you pick one and be consistent.
E)  there is no need to overdescribe some statistical tests, such as in chi-squared, the sentence
"This helped identify potential associations between progesterone levels and key clinical
outcomes, such as embryo quality classification.",or in Pearson's "It provided insights into how
variations in progesterone levels correlated with oocyte retrieval outcomes."
F) I would not describe methods I did not use. I would remoce the sections on multivariate and
logistic  regression altogehter.
G) The sentence "This comprehensive statistical approach ensured a robust analysis of the data,
allowing for valid and reliable conclusions to be drawn regarding the relationship between serum
progesterone levels and oocyte maturity and embryo quality in the context of IVF treatments."
is unnecessary
RESULTS
H) I would remove the first paragraph, as it appears to repeat the research strategy,  and to outline
what you will describe, This is not needed.
I)  I would begin my results describing my study population, which should match your table 1.
You jump right into progesterone levels.
Also, ranges are not good measured of dispersion, please report IQRs instead
J) How did you decide the initial 1.2 cutoff?
K) If the progesterone cut-off is your main exposure, then your table 1 should be stratified by
progesterone levels, which it is, but by rows. I had recommended that you structure your tables
with the group A and group B by column, but you decided not to because of the P-values
I still strongly think that the table would be much easier to follow if Group A and Group B were
columns. You can still include a P-value if you structure your table like this
L) The title of your table 1 could be shortened for conciseness
M) I think Table 2 is mostly unnecessary and could be described in text, but personal decision .
N) In table 2 you describe the groups as "<1.2" and "#1.2", but in Table 1 you call the Groups
A and B. I would use a consistent term across. This table 2 however, with the groups at the top,
are easier to follow.
O) The title of your table 3 is too long. Please give an informative title, and move the description
of the groups to the table footnote
P) Your figure 1 and ROC curve are adequate now
Q) The name of your figure 2 is too long. Please provide a concise name. the rest of the
explanation has already been presented in the results
DISCUSSION
R) I strongly suggest that you change your first paragraph by clearly starting with your most
impoortant results. You begin explaining the role of progesterone. Only do so if you will tie
it to your own results. I would actually start in "the key finding of our study was..." and then
elaborate.
S) The issue that I have with the 1.54 is that it is very specific to your cohort, as this was not
determined by any statistical or machine learning techniques. had that patient had a different
progesterone level, you would be recommending a different threshold. How different was the
progesterone for the preceding and subsequent pariticipant?