Reviewer’s report
Title: 
Falsely elevated serum estradiol in woman of reproductive age led to
unnecessary intervention and delayed fertility opportunity: a case report and
literature review
Version: 
0 
Date: 
22 Oct 2021
Reviewer: 
Ibrahim A.
Reviewer's report:
Dear Respectable editor 
Thank to give me the opportunity to review the case report entitled (Falsely
elevated serum estradiol in woman of reproductive age led to unnecessary
intervention and delayed fertility opportunity: a case report and literature
review).
The authors present A 28-year-old female with pregnancy demand was
diagnosed with polycystic ovary syndrome, Hashimoto's thyroiditis and
subclinical hypothyroidism, and found with persistently elevated levels of serum
estradiol in early follicular phase (between 527 and 642 pg/mL). 
Serum tumor biomarkers were normal. Abdominal and pelvic computed
tomography were negative for adrenal or adnexal masses. A left mesosalpinx
cyst and benign pathological results were achieved by laparoscopic surgery.
Falsely elevated estradiol level was suspected for the discrepancy among high
estradiol, follicle growth and normal gonadotropin. Immunology interference by
heterophile body was finally verified by two competitive chemiluminescent
immunoassay platforms (estradiol levels in early follicle phase: 619 pg/mL,
Siemens ADVIA CENTAUR and 60 pg/mL, Beckman, DxI 800). Successful
clinical pregnancy was eventually achieved by combining induced ovulation,
ultrasound monitoring and intercourse guidance.
The authors concluded that analytic interference and laboratory error should be
suspicious at first when the clinical characteristics contradict laboratory results.
Measuring serum estradiol with another immunoassay platform is an easy and
non-time-consuming method to exclude the heterophile interfering.
The authors used an informative title and abstract suitable for case report. They
discussed the case-report in detail, and they compared their findings with other
findings in the discussion. They reached clear conclusion reflecting their findings
and they used relevant references. The case-report can be accepted without any
suggested suggestions from myside.
Regards 
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