Reviewer's report 
 Surveying of Relationship between Anxiety, Depression and Duration of Infertility Title: 
 4  14 March 2004 Version: Date: 
 Hidehiko Matsubayashi Reviewer: 
Reviewer's report: 
General 
This revised manuscript is much better than the first one (c.f., the methods and results), but there is 
so much points that the authors should revise. This article will be very worthwhile for contribution if the authors explain more detailed points of social, cultural, and economical background in Iran, 
because the readers didn?t know well about Iranian people. The introduction and discussion is still 
too poor on logic-flow to understand. ------------------------------------------------------------------------------- Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
This revised manuscript is much better than the first one (c.f., the methods and results), but there is 
so much points that the authors should revise. This article will be very worthwhile for contribution if 
the authors explain more detailed points of social, cultural, and economical background in Iran, 
because the readers didn?t know well about Iranian people. The introduction and discussion is still too poor on logic-flow to understand. 
1) Results and Tables became much better than before, but some points should be changed or 
added. Table 1; Total number of patients should be on the table. Table 2; The authors should explain each cause of infertility (e.g., how to evaluate those, what kind 
of tests your hospital used (including laparoscopy?), What is the cutoff line of those tests in your 
hospital, and What does ?habitual? mean). The common in Iranian hospital is not the same as that 
of other countries. It is not still clear which groups were compared (Table 2, page 9, 4-6). Would you 
please clarify those in the results and show p-value in the Table 2 (Is that multiple 2 x 2 tables or 2 x 
n table?). To clarify which groups are compared, it is necessary to separate groups and to show P 
value in the Table 2. In results section, instead of ?Table 1 displays the detailed results?, just say ?(Table 1)?. Table 3 and 4 is the same. 
2) The authors should explain more about statistical methods in the end of the method section. 
3) Page 7; We need references of the validation study of both Beck Depression Inventory in Persian 
version and Cattle Inventory in Iranian version. Those may be written in Persian or Iranian (not in 
English), but you should cite those references in addition to the original version. 
4) The Introduction and discussion sections are important, because many similar studies have been 
published recently but it was rare for Iranian population. This is the point. Why your study showed such high depression and anxiety level in comparison with other studies? The authors should explain more detailed points of social, cultural, and economical background in Iran, because the 
readers didn?t know well about Iranian people. The authors just cited and listed the papers in the 
discussion, but they should compare Iranian to other countries using those references. For example, 
how is important to have a child in Iran, how do surrounding people say to the infertile women 
(husband, parents, parents in law, neighbors etc.), how long does it take to divorce without children, 
how often does the divorce occur, can man marry with more than 1 wives? After discussing these, 
prevention of the surge of depression and/or anxiety in 4th to 9th years of infertility period would be 
important. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
1) Do not use Arabic numerals in the top of the sentences (e.g., page 8, line 16; page 10, line 8). 
Those should be spelled out. For example, ?293 women? changed to ? Of these, 293 women?. 2) Many colloquial still appeared in the article (e.g., page 10, lines 15-17; and A and B and C). That 
would be changed in the style of scientific paper. 
3) ?Between A and B? is right, but the authors used that ? between depression and anxiety and C?, 
which can be changed that ?between depression and/or anxiety and C?. (e.g., page 9, lines 10-13; 
page 9, lines 18-19) 
4) Page 8, line 18; the authors should omit ?about?, because 40.8% is calculated. 
5) ?severe significant and positive relation? is not right, just say ?significantly related (r = + or -, p = )?. (e.g., page 9, line 9; page 9, line 13, 15) 6) page 9, line 19; ?T-test? would be ?unpaired t-test? or ?paired t-test). 
7) Page 9, line 20; ?P < 0.01? would be ?P = 0.003). 
8) In many part, ?anxiety and depression? was used like one word, but it would be ?anxiety and/or depression?. 9) Page4, line 4; ?That? would be omitted. 
10) Page 4, lines 5-7; Unfortunately, many obstetricians and gynecologists did not think that the 
psychogenic infertility is true. Very small amount of researchers like Domar (reference #2) have published several manuscripts to say such topic. It is almost 10 years. 
11) Page 4, line 17; The reviewer does not think ?very recent? study is ?#9, 1999?. It is 5 years ago. 
12) Pages 5 to 6; It would be the story with logical. Need more corrections. 
13) Page 12, line 18; ?during first years (1-3)? would be ?during the first three years?. 
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Discretionary Revisions (which the author can choose to ignore) 
None 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of limited interest Level of interest: 
 Not suitable for publication unless extensively edited Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
None