Title: Endometrial Microstimulation Effects on Endometrial Receptivity Assessed by
Transvaginal Color Doppler Sonography
Version: 2 Date: 29 Jul 2022
Reviewer:  R. Silva Martins
Reviewer's report:
The Effect of Endometrial Microstimulation on Endometrial Receptivity Assessed by
Transvaginal Color Doppler Sonography
First and foremost would like to appreciate the authors for the work developed and the originality
of the study presented.
Endometrial receptivity has been for quite long time a hot and controversial topic in
Reproductive Medicine, and means to successfully evaluate has been a challenge for many study
groups throughout the years.
However some items are required in order to comply with the nature and scientific level of the
publishing journal.
1. An extensive review of grammar and spelling is required and I would personally suggest the
revision of this manuscript by an English Native Speaker.
2. Abstract is quite short, and perhaps lacking important and relevant information in order to
have a full scope of the nature of the study developed by this group.
3. Results in the Abstract section is perhaps the one that requires more work, as it almost says
nothing. Some numbers or a clarification of what actually is supposed to be seen as statistical
different between the two groups is required.
4. Relevant information is required because in the discussion part of the abstract its claimed a
difference between the two groups but its not clear what sort of difference was noted.
5. Still, in the abstract, the conclusion is blunt and not based on actual data that is required in
order to claim the difference noted between the two groups.
6. Introduction : a more in depth information is required, and some spelling is also needed ( eg.
Halfway in the text some “ is seen but its not clear if that’s a typo or something relevant )
7. Not clear also the purpose of this work – one claims that the use of a non invasive technique
to determine endometrial receptivity by the means of ultrasound, using an invasive technique to
further enhance that so called receptivity?
8. Why in fertile women without previous story of infertility would one induce an invasive
procedure to further enhance the natural capability of conceiving ?
9. Not clear why infertile women were an exclusion criteria – and how was that determined and
evaluated? How could one be absolutely sure that women in this set group were not infertile
– and more so even in women with previous natural conceived children if they are not in the
present time themselves suffering from some sort of infertility or subfertility?
10. Methods – how was this microstimulation induced ? by hand ? manually ? how can one be
sure that the same physical effect is produced in terms of microstimulation without any given
proof of the strength and resistance offered and produced upon the endometrium ?
11. Biopsy by microstimulation ? Can’t understand this part. And in the control group how
endometrial pathology was assessed?
12. Endometrial movement – that’s for me the tricky part of this manuscript. How was this
observed and registered? Is a subjective measurement… assessed by the operators look and
feels?
13. Also, how many operators performed the different tasks – was it always the same one
producing in all subjects the microstimuation, was it the same one observing the endometrial
movements on ultrasound ? If not .. how many participated and what was the inter observer
difference ? Was it measured ? How that would affect results ?
14. Why was pulsatility index defined clearly but resistance was oblivion to a definition ?
15. Comparing endometrial pathological findings its claimed that group A and B are similar
but the number of subjects from Group B suddenly gone from 60 to 30 – what happened to the
remaining 30?
Overall the topic, and the study shine a brighter an innovative light in endometrial receptivity,
but the methodology used lacks a bit of scientific accuracy in order for this manuscript to be
published at its current state.