Title: Fertility specialists’ views, behavior, and attitudes towards the use of endometrial
scratching in Italy
Version: 3 Date: 12 Dec 2022
Reviewer:  Kiri Beilby
Reviewer's report:
The manuscript titled 'Fertility specialists’ views, behaviour, and attitudes towards the use of
endometrial scratching in Italy' set out to investigate the use of  ES by fertility doctors, and
also considered how it is advertised to patients on clinic websites.  The authors have designed a
comprehensive survey that covers many domains of doctor choice and experience in offering ES
as an adjunct infertility treatment, and this information adds value to our current understanding
of how treatments are presented to patients. In addition, the authors consider how ES information
is provided to patients on clinic websites, which provides valuable insight into the customer
experience and how this intersects with the clinician experience. The manuscript is well written
and easy to follow, with only small errors that are the  natural consequence of translation from
Italian to English. The content fits the scope of the journal, and I recommend the manuscript be
accepted for publication. However, I do have some concerns regarding the presentation of the
methodology and results that I think need to be revised prior to publication. I will detail these
broadly below, and have included specific comments for consideration as track changes in the
returned manuscript document.
First, the methodology describe is either incomplete, or incorrect. The survey design used,
and the website analysis performed are both forms of quantitative data collection. The authors
mention a thematic analysis of open answer questions (I think - it is not described this way but
I am inferring), but this analysis is not included in the results section. Therefore, as I see it, this
is not a mixed method study design, but rather a quantitative study that uses a non-validated
instrument (hence no statistical analysis) to 'observe' clinician experience and perception -
without the statistics these can not be measured, per se. Likewise, the website analysis provides
proportions of websites that do or do not display certain author-defined criteria, but does not
measure the quality of each site in entirety. I have suggested a reference in the track-changed
mark-up I've included in the returned document. Also in relation to the methodology, the authors
are inconsistent in how they refer to the study - sometimes as quantitative and sometimes as
qualitative. This needs to be standardised.
The results section is tricky to read, and I don't think it adds a lot of value from a communication
perspective to painstakingly report %s, especially as without detailed context regarding the
choices offered its confusing to read. Table 2 summarises the findings well, therefore I suggest
describing the main findings as they have been established in the methods section with regard
to topics that are observed by specific items - this will create a direct link between the sections
and strengthen the narrative.
Finally, also regarding narrative, it is unclear how the authors intend to link the two parts to their
study, or what they are trying to answer with these very different components. (I mean, it is clear
to me, but not overtly stated as a study aim). I think it would strengthen the author's scientific
approach to clearly state what the research questions are for both studies, and how these studies
intersect to reflexively add to a better understanding of ES use in Italy.
Finally, thank you for your work! I enjoyed reading it and think it makes a valuable contribution
to our field.