Reviewer's report
Title:Relationship satisfaction in lesbian and heterosexual couples before and
after assisted reproduction: a longitudinal follow-up study
Version:1Date:12 August 2014
Reviewer: Katherine Péloquin
Reviewer's report:
This study examined relationship satisfaction in lesbian and heterosexual
couples before and three years after undergoing fertility treatment. The study had
numerous methodological strengths, including the recruitment of a large sample
of couples in multiple fertility clinics in the country and the longitudinal design.
The focus of the study, ie, relationship satisfaction and functioning, is also
interesting as most studies in fertility have focused on individuals and individual
adjustment (mental health, quality of life, etc.). Using both partners of the couple,
instead of the treated partner only, is another strength. The study presents a
number of important problems which I address in turn below, with the hope that
my comments will help authors improve their paper.
Major compulsory revisions:
1. Although the authors do discuss the major study variables in their introduction
(some demographic variables related to marital satisfaction, ART treatment,
impact of parenthood), the rationale for the study is not established well enough
to justify the three objectives formulated. The emphasis appears to be on lesbian
couples, whereas the study is concerned with both lesbian and heterosexual
couples. Are there any known differences between these two populations in
terms of relationship satisfaction and impact of ART and children ? Also, why is
this relevant to conduct this study ? What are the implications? How will this
further research/knowledge advancement? Does this study address prior
research limitations and what are they? The paper would be more interesting if
these points were addressed in the introduction.
2. The introduction should also address two variables which are the focus of the
study: treatment outcome and which partner receives the treatment. Are there
other studies that have looked at these variables and what did they find? Overall,
the study needs to be better put in context of prior research with respect to all
variables assessed in the study.
3. Authors don’t seem to have taken into account the fact that data from couples
are dependent and cannot be compared as would nondependent data. A paired
sample t-test or its nonparametric equivalent needs to be conducted (Wilcoxon
sign rank test) when using two related samples (two partners of a same couple).
This should have been done when comparing scores from each partner.
4. Also, a paired-sample t-test was used to compare data from T1 and T3. I am
wondering why this test, instead of a nonparametric test, was used here if the
data was not normally distributed. Authors should report which variables were
normally distributed and which were not, as also specify whether variables were
positively or negatively skewed.
5. p.10, line 217: what kind of statistical analysis was performed ? A repeated
measure MANOVA ? Please specify.
6. p. 10, line 226: what kind of statistical analysis was performed ?
7. p. 10: the analyses and results for education are not clear. What is meant by
“the greatest difference were amongst women with high school degree” ? What
were the other educational degrees ? What kind of analysis was performed ? The
groups and analyses should be more clearly defined. Means and SD should be
presented for all groups. The same comments applies for analyses pertaining to
age.
Minor essential revisions:
8. P. 3, line 66: Please specify if a negative or a positive correlation was
observed between the presence of children and marital quality in Ducharme’s
study.
9. Errors in written English:
-P. 4, line 74 : Please review the quality of written English in this sentence : «
The first year of parenting has been described to be particular (PARTICULARLY)
vulnerable (TO WHAT?) and many of (REMOVE “OF”) divorces take place
during this time.
-p. 4, line 75: Please make this correction: “Although the child and parenthood
ARE highly…”
-p.4, line 82: Please review written English for the first objective of the study.
-p.6, line 123: Please review written English for the following sentence “Both
couples with a successful as WELL AS WITH an unsuccessful treatment
responded to the questionnaire”
-p.6, line 124: It should say Table 1 instead of Figure 1.
-Overall, the quality of written English should be edited. English also being my
second language, I defer this task to individuals whose first language is English.
The English language, as it is now, unfortunately makes it difficult to understand
the analyses and results of the study.
10. In all tables: under the heterosexual columns, it should say father (not
co-mother) and under the lesbian columns, it should say co-mother (and not
father).
11. When describing the ENRICH inventory, the 10 dimensions should be
defined.
12. p.9, line 200: what does PCA-scores mean ?
13. p.9, line 203: authors refer to figure 2, but no figure was provided. Is this
missing ?
14. p.9, line 207: authors say “treatment outcome affected on lesbian couples’
relationship satisfaction…” authors should be careful not to infer direct causation
here, as treatment outcome was not manipulated. One can only say that
outcome was related to couples’ satisfaction scores.
15. p.10: means and SD on ENRICH dimensions should be reported for couples
according to treatment outcome groups (successful vs unsuccessful treatment).
16. p.10, line 226: Again, what is PCA scores ?
17. I am wondering why authors did not include T2 as part of their study. If the
research question was to investigate the potential impact of ART on couple
relationship, assessing satisfaction much closer to the end of treatment would
appear more relevant. Although very interesting, the time 3 data is not as
proximal to the ART treatment and other factors could explain the observed
group differences. This should be discussed in the limitation section.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.