Title: Evaluation of endometrioma size effect on ovarian reserve, embryo quality and pregnancy
outcome after in vitro fertilization cycle; a cross-sectional study
Version: 1 Date: 30 Jan 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I read with great interest the manuscript ""Evaluation of
endometrioma size effect on ovarian reserve, embryo quality and pregnancy outcome after
in vitro fertilization cycle; a cross-sectional study"", which tries to shed new light on a very
important topic. Despite I appreciate the efforts of the authors in designing and conducting this
cross-sectional study, in my honest opinion several major revisions are necessary to improve
the quality of the manuscript.
REQUESTED REVISIONS:
I hereby list some recommendations to improve the quality of the manuscript:
- The text needs to be edited by a native English speakers, in order to improve grammar and style.
- Introduction: authors should clearly highlight that surgery for endometrioma prior to ART
can be considered only to improve endometriosis-associated pain or accessibility of follicles,
according to the guidelines for the management of endometriosis by the ESHRE (refer to: PMID:
35350465). Indeed, as appropriately stated by the authors, clinicians are not recommended to
routinely perform surgery for ovarian endometrioma prior to ART to improve live birth rates,
as the current evidence shows no benefit and surgery is likely to have a negative impact on
ovarian reserve.
- Methods: how did the authors calculate the sample size of 70 women affected by
endometriomas and 70 age-matched controls? How do they know that the study is powered
enough to measure statistical differences for the primary outcome?
- Methods: did the authors exclude women with superficial peritoneal endometriosis or deep
infiltrating endometriosis? If they did not, this represents a significant bias of the study.
- Methods: did the authors check also for Antral Follicle Count (AFC)? If they did not, they
should explain why.
- Methods: The primary outcome should be only one (and the sample size should be calculated
on this primary outcome); all the rest of the outcomes should be considered secondary outcomes.
- Methods: authors should provide precise details about IVF stimulation protocol(s).
- Methods: did this study conform with the Strengthening the Reporting of Observational
Studies in Epidemiology (STROBE)Statement, validated by the Enhancing the QUAlity and
Transparency Of health Research (EQUATOR) network? It would have been mandatory to
follow this guideline standard.
- Discussion: authors should discuss novel pieces of evidence about the potential predictive value
of basal serum progesterone for successful IVF, as well as the potential effect of the so called
""integrated approach"" (i.e., surgery + IVF), in women affected by endometriosis (authors may
refer to: PMID: 36294778; PMID: 29274003).
- I recommend to highlight and discuss the potential use of pretreatment with progestins (for
instance, dienogest) in women with endometriosis in order to IVF outcomes, and the results of
the SAFE (Surgery and ART For Endometriomas) about the effect of endometriomas on ART
parameters (authors may refer to: PMID: 32873492; PMID: 34585638)."