Reviewer’s report  
 
Title:  Follicular flushing increases the number of oocytes retrieved in poor ovarian responders 
undergoing in vitro fertilization: a retrospective cohort study  
 
Version:  0 Date:  10 Jul 2018  
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
"PEER REVIEWER COMMENTS: To view the full report from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: This is an interesting study that looks at the 
benefits of follicular flushing to increase the number of oocytes retrieved in poor ovarian 
responders. It has some interes ting data and  conclusions.   
 
I am unsure how this can be described as a retrospective study. Is it therefore routine practice at 
this clinic for the initial aspirate and all subsequent flushes to be analysed separately and 
recorded individually. That woul d be very labour intensive and surely only done within the 
parameters of a prospective study?  The authors say this is as a retrospective study but the 
description is of a prospective study unless the standard notes made in routine practice are 
elaborate e nough to find this data. And why would the practitioners keep going to exactly 9 
flushes without being part of a prospective study? This needs to be explained and discussed in 
more detail by the authors.  
 
The use of a  dual lumen needle at 140mmHg is described. Perhaps a future study could compare 
flushing outcomes dual versus single lumen needles.  
 
 
REQUESTED REVISIONS:  
 
The design needs to be explained in more detail - if this was retrospective, is it stan dard practice 
to perform oocyte retrieval in this way and to record each aspirate individually?  
 
The actual analysis and representation is good.  
 
The interpretation is appropriate.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
The points I have raised earlier re the t ype of study need to be clarified."  
 
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.  
 
No 
 
Are the conclusions 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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify 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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consid ering 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 financially from the publication of this 
manuscrip t, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either n ow 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 inter ests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication  of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the revie wer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website  along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that an y comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal