Reviewer ’s report  
Title: Impediments to communication and relationships between  infertility care providers and 
patients  
 
Version: 0 Date: 30 Apr 2017  
 
Reviewer: Trudie Gerrits  
 
Reviewer's report:  
Overall comment  
 
This manuscript addresses an interesting and relevant theme in the field of reproductive 
medicine, namely the tension between the needs for PCC from the side of the patients and the 
way providers are aware of and able to provide such care. For this reason  the author has 
interviewed patients and providers. However, I noticed inconsistency between this aim and the 
way the manuscript is framed and structured.  This starts with the title (only speaking about the 
challenges the providers face), continues with t he research questions (only about the providers 
perspectives) and also returns when the instruments are discussed (only questions posed to 
providers are mentioned).  I suggest the author to improve the consistency between all elements. 
In addition, the str ucture of the article/results section should be better presented: going from 
(briefly) sketching different perspectives about PCC, looking into different aspects of this and 
the trying to explain these differences. Take the reader more 'by the hand'  
 
Quest ions / remarks  
P4  
* what definition of PPC is being used  
* line 11 -12: give refs [5 and 6] I assume  
* line 12 - only about women suffering form infertility? what about men?  
* talking about patients - are they patients or rather women and men facing fertility problems?  
 
P5 
Too many different research questions presented. The overall aim or research question should be 
more clearly given. See above general comment (research ques tions are only about providers)  
P6 
line 5 -6: mention Geertz in text; 4 -7 reads a bit awkward.... rephrase  
* Context is referred to, but hardly any context provided in the article. Mention country of 
research (and states) earlier in text and provide insight  in contextual relevant aspects, e.g. is this 
about private or public clinics; health insurance covering IVF; costs  
* selection of participants:  
Not clear how patients were selected? Did they also attend ASRM meetings? Purposively?  How 
selected? At what s tage of treatment were they when approached and/ or interviewed? (Seems to 
make a big difference in how they perceived the PCC)  
* With regard to the 'other providers':  on page 7 it is stated that 8 mental health providers were 
interviewed; If 8 out of the n were mental health providers, what are the other two? mention more 
specifically.  
P7 
* Additional interviews? Not clear how used? Were they not used in the analysis because 
saturation was reached? Explain better?  
* Were all interviews conducted by phone?  With providers and patients? How did this affect the 
interaction and flow of the interview? Any reflections on that? Were interviews recorded? With 
permission?  
 
* Instruments: no questions for patients presented  
* First question (What challenges...) very broad. Did they know that the focus was on PCC?  
 
P9. 
* line 21 -30: seems redundant compared to the above  
 
p10 
Differing perceptions ...  
Overall, this section is quiet superficial: It does not seem to reflect all elements of PCC? This is 
also related with t he earlier remark that it is not clear what definition of PCC the author uses.  
Doctors trying to provide PCC:  
* providers quotes only show that the providers are committed and involved; that does not give 
sufficiently insight in how they see or try to prov ide PCC?  
 
p11 
Patients feeling providers are often callous  
* Use of 'many patients' ... 'others' ... what does this mean when only 10 patients were 
interviewed? Or is it that patients may have both feelings (at different stages, with different 
doctors/clinics)  
* Interesting remark: patients more satisfied when the y end up with a baby - underlines 
importance of saying at what stage of treatment patients were interviewed  
* Some parts of quotes are underlined - what does this mean? (Throughout the text)  
 
p12  
line 48: Unfortunately - not needed; enough to say that it  happens.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
Are the conclusio ns drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
Needs some language corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that  may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, eith er now or in the future?  
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
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below. If your reply is yes to any, please give details below.  
 
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