Reviewer’s report
Title: 
Analysis of the etiologies of female infertility in Yunnan minority areas
Version: 
2 
Date: 
09 Oct 2020
Reviewer's report:
General comment
a. The study is topical and relevant to women's public health. 
b. Page numbers should be included in the manuscript to enable the reviewer
refer the authors to specific areas in the manuscript.
Abstract
a. The sample size should be stated in the Methods sub-section of the Abstract
(Page 4, Lines 1-9)
Background
a. The background has articulated a researchable problem. This is commended.
b. There is an error in the definition of infertility provided. It should read "…and
have lived with their partner for one year…" not without. (Page 4, Line 48)
c. The aim(s) and objectives of this research are not provided. In addition, what
is the relevance of this study to women's health, how will it contribute to
knowledge and/or practice
d. More detail should be provided on how infertility affects the health and
economic situations of sufferers and their families. (Page 5, Lines 3-6)
Methods
a. What was the study design?
b. How was the sample size calculated?
c. What type of sampling was used to select the medical records? If a total
population sampling was done this must be stated. 
d. The section "General data" would better read as "Study population and sample
size" (Page 5, Line 17)
e. The section "Diagnostic criteria" would better read as "Inclusion criteria"
(Page 5, Line 31)
f. Having another sub-section titled Methods (section 1.4) is confusing. This
should be renamed "Data collection" while section 1.5 renamed "Statistical
analysis" and merged with section 1.6. (Page 6, Lines 11, 31, 47)
g. Medical records were obtained from doctors in the two hospitals via
consultation. It is not clear what the authors mean by "consultation". Do you
mean interview? Was a study instrument used, may be a questionnaire? A
checklist? Or was a proforma used to extract information from the patient
records? It should be stated and adequately described in terms of its content,
whether it is an adapted instrument or was designed by the authors. (Page 6, Line
14)
Methods: Statistical analyses
a. The use of Pearson Chi-square test and logistic regression analysis assumes
that the data was obtained through random (probability) sample selection. The
appropriateness of this choice of statistical methods depends on the response to
comment 4c above (Page 6, Lines 50-56)
b. Pearson Chi-square is used for comparison of proportions not rates. This
should be corrected. (Page 6, Lines 53)
Results
General characteristics
a. It would be good to have the data on general characteristics presented in Table
1 along with the data on BMI
b. P should be written as P value everywhere it appears
c. The actual P values obtained should be stated (including in tables) and not
merely saying < or > 0.05
d. (1) What were the minimum, maximum and mean ages in each group/region?
(2) Was the difference in mean age statistically significant?
e. It is not clear what is meant by "high educational background?" Does this
mean secondary school and higher, above primary school, postgraduate? This
needs to be clear.
f. What proportions lived in the urban and rural areas? Please be specific.
g. More detail should be provided on the analysis of number of sexual
encounters per week.
Analysis of factors influencing infertility in patients
h. The text needs to be clearer on what the authors did.
i. What were the reference categories for each variable assessed in the logistic
regression model? 
j. The phrase "mainly affected by" is ambiguous and vague. The authors need to
be specific in comparing the estimated risk between categories of the variables
based on the 
odds ratios (Exp B) obtained e.g. In Dehong region, patients who had pelvic
inflammatory disease were almost four times likely to be infertile compared to
those without 
(odds ratio, 3.716). (3) The 95% confidence intervals of the odds ratios should
be included in Table 4.
Etiologies of infertility [in] the two regions
k. "Organic diseases," do you mean "pathologies"? Pathologies would be a better
terminology. (Page 9, Line 20)
l. The same refers to the term, "pathogeny" in Table 5. Correct to "Pathology."
Etiologies of infertility in patients with primary infertility in the two regions
m. Include the proportions for the etiologies mentioned e.g. ovulation disorder
(36.71%)
Etiologies of infertility in patients with secondary infertility in the two regions
n. Include the proportions for the etiologies mentioned 
Tables
o. (1) Tables should be able to stand-alone without reference to the text. (2)
Table titles should contain information on the sample size and mention the two
regions by name. 
(3) The total sample size (N) for each region should be included to enable the
reader make sense of the percentages
p. Footnotes explaining abbreviations used in the tables should be included
q. P should be written as P value
r. In Table 1, (1) a footnote with BMI written in full should be included. (2) The
unit of BMI (kg/m2) should be included. (3) The categories of BMI should be
named in addition 
to the range i.e. Underweight <18.5; Normal 18.5-24.9; Overweight ≥25
s. Table 2, PCOS should be written in full in a footnote
t. Table 3, G, χ2should be written in full in a footnote
Discussion
a. The authors need to compare or contrast the findings from the study with
findings from the literature. Have other studies reported similar or contrasting
results?
b. The term "incidence" is used inappropriately. This is a retrospective study and
incidence cannot be determined due to its cross-sectional design. "Proportion"
would be a better term to use. (Page 11, Lines 50-59)
c. The authors stated, "This might be correlated with the high abortion rate found
in infertile patients in Kunming." This appears to be a finding from previous
research and must be appropriately referenced. (Page 13, Lines 20-23)
d. The limitations of the study should be discussed. Are there any possible
cautions the reader should take in interpreting or generalizing the findings?
References
The reference list should be revised in accordance with Vancouver referencing
style. For example, abbreviations for journal titles should be consistently used
through out the list; For article, chapter or section titles - capitalise only the first
letter of the first word, and the first letter of the first word after a colon etc.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes