Title: Fertility awareness and subclinical infertility among women trying to get pregnant at home
Version: 5 Date: 05 Oct 2021
Reviewer's report:
Thank you for the opportunity to review the manuscript titled “Fertility awareness and
subclinical infertility among women trying to get pregnant at home”. The topic is important
to explore in relation to women’s health. However, the manuscript requires major revision
regarding the accuracy of reporting. The background section also requires further revision to
clearly contextualise the importance of the current study. Please see comments below (divided
into section and lines) for further feedback.
Abstract
20 Reconsider the use of the word ‘avoid’ in the sentence “…to avoid involuntary childlessness”.
Perhaps ‘reduce’ or ‘minimise’ may be more suitable.
Background
13 - 16 This section about the availability of information about infertility in the digital age. This
point could be elaborated on a little further and may help to justify why the use of the Lunaluna
app was a sound approach to data collection for this study. Additionally, the sentence “They
have been distributed among women who wish to conceive” needs to be better linked to the
previous sentence. Perhaps instead of the word ‘distributed’, it could be ‘…easily accessible
among women who wish to conceive’ and expand on why this technology is noteworthy in
reproductive health.
18 – 20 The sentence beginning with “The aforementioned facts suggests…” needs to be re-
worded and the link to university students in the following paragraph needs to be made. As
it stands, it is a little disjointed. Further, the relevance of including university students in the
discussion needs to be made clearer.
24 – 26 The sentence beginning with “The differences in the environment and fertility
awareness…” needs to be re-worded/re-phrased as it is unclear why a comparison between
university students and women trying to get pregnant is being made. Additionally, the phrase
“trying to get pregnant at home” could perhaps be re-worded to ‘natural conception’ or ‘conceive
naturally’ for clarity.
Materials and methods: Participants and procedures
1 Suggest add a sentence or two to describe why the Lunaluna app was chosen as the platform
for this study and list its functions that made it a good choice for data collection.
3 Ethical considerations need to be discussed in a little more depth, particularly in relation to
the participants’ personal data. This is of concern particularly if the app is third party and not
developed by the researchers/
9 – 12 The inclusion and exclusion criteria could be better outlined for clarity.
Materials and methods: Measures
17 - 19 Suggest include a brief explanation of whether the survey was pilot tested for validity
and reliability, or if it was previously tested for validity and reliability.
20 – 46 The explanation of the six sections and the type of questions included in each section was
difficult to follow. Suggest present the question in each section in order of which they appear,
for clarity. For example, lines 20 – 24, it states that the first five questions were open-ended.
However, as it is listed, the first five questions refer to age, body weight, height, medical history,
periods of infertility. Some of these questions are likely not open-ended questions.
34 – 35 The questions listed in these lines require some editing in relation to grammar. This may
be due to translation and may not be changed. Perhaps a statement regarding translation of the
questions for the manuscript is required.
44-46 Perhaps a statement regarding the partner’s demographic information is needed to justify
why this was included. This could also be included in the discussion section.
Results
3 – 4 Please clarify whether the 582 women who had children were of the 1247 married women
in the sample.
7 The word ‘childbearing’ reads as if it should be ‘conception’. If not, please re-word/rephrase
for clarity.
9 – 26 A brief statement about why only a few sections were reported on could be included.
Perhaps the other sections of the survey will be reported in another paper.
30 – 31 The link between figure 2 (Awareness of infertility and the prevalence of subclinical
infertility) and the first question from table 2 ( In general, what age do you think women can get
pregnant until?) is not clear. Perhaps a brief explanation of the relationship is needed to clarify
the relationship between figure and table 2.
40 - 44 Results presented in relation to OR, CI and P value is not consistent with what is presented
in table 3. Please check and ensure that results are accurately reported.
Discussion
29 The sentence beginning “Our results revealed another problem…” requires editing. Perhaps
“Our results revealed another problem that had not been discussed well in the literature.”
32 – 34 The sentence beginning “The previous surveys on … “ is an interesting point. The
European and American studies referred to in this sentence could be elaborated on to include a
discussion on the ‘images of infertility’ and how they differentiate from those present in Japan.
47 – 48 The sentence beginning with “Japanese women who often harbor…” is an interesting
point and could be incorporated in a little more depth in the background and/or discussion
section.
52 – 54 Spelling error ‘forth’ should be ‘fourth’. This section will require editing for grammar,
particularly the sentence “It might be information bias”.
Conclusion
1 – 8  Some specificity could improve the conclusion particularly in relation to “more than a few
patients” (line 1), “several reasons” (line 3), and “the problems” (line 7). For example, ‘more
than a few patients’ could be clarified to say “According to our investigation, there may be a
significant number of women with subclinical infertility”.