Title: Associations between health-related quality of life, infertility-related psychological well-
being, and relationship quality in individuals with endometriosis: A cross-sectional study
Version: 2 Date: 17 Oct 2024
Reviewer:  Allyson C. Bontempo
Reviewer's report:
Manuscript Review
Thank you for the opportunity to review this revised manuscript, entitled, “Associations between
health-related quality of life, infertility-related psychological well-being, and relationship
quality in individuals with endometriosis: A cross-sectional study.” This is an important topic
in the context of endometriosis that is suitable for this journal. This reviewer believes this
manuscript can be strengthened by incorporating the feedback from myself and the other
reviewers.
General
1. The authors switch between past and present tense throughout the manuscript. Could the
authors please use the correct tense when appropriate?
Abstract
1. Line 12: There is a movement to move away from centering endometriosis as a gynecological
disease and instead a full-body, systemic disease. This could be reflected in this section.
Furthermore, endometriosis is the most common “gynecologic” disease.
2. Line 13: Is it necessary to frame endometriosis as benign?
3. Line 19: The authors introduce constructive communication in the methods, without having
included it as a variable in the background with the others. Thus, it appears to come out of
nowhere.
4. Lines 21-24: Mediation analysis for constructive communication is described, but the
measurement of constructive communication is not mentioned in the Methods section.
5. Lines 33-35: There is no object to this sentence. Furthermore, full mediation is not specified
in the Results, only here, and thus it should be specified in the Results first.
Introduction
1. Lines 39-40: There is a movement to move away from centering endometriosis as a
gynecological disease and instead a full-body, systemic disease. This could be reflected in this
section. Furthermore, endometriosis is the most common “gynecologic” disease.
2. Line 55: “Stress trying to get pregnant”: This is missing a word.
3. Lines 63-64: “It seems to be the most challenging dyadic stressor.” Was this specifically found
in one study or a conclusion from the literature? Using the word “seems” makes this unclear.
4. Line 76: “Partnership quality”: Please use the same terminology (“relationship quality”)
throughout the manuscript.
5. Lines 79-80: “Feelings and emotions”: These are the same thing.
6. Line 83: “In this area”: Could the authors please specify?
7. Line 85: “Not being understood”: This is not an emotion, it is a belief.
8. Line 91-92: “After all…”: What is the source here?
9. Lines 96-97: The authors should go beyond stating that the research is scarce as a reason for
investigation.
10. Lines 97-100: Where does constructive communication fall in here?
Methods
1. Line 121: “Female”: Was this sex assigned at birth or gender?
2. Lines 144-145: “A score of 30…”: Please cite.
Results
1. Good reporting of results.
Discussion
1. With a few exceptions, the authors stop abbreviating their constructs and spell out the full
variable terms (“health-related quality of life”). Could the authors please use these abbreviations
so it remains consistent with the rest of the manuscript?
2. Lines 279-280: “More studies…”: Again, this is not identifying a gap in the literature.
3. Line 282: “Empirical”: Qualitative research is empirical.
4. Line 286: “…persons who suffer more…”: Patients can suffer in a variety of ways. Authors
should state explicitly what they measured (i.e., HrQoL)
5. Line 291: ”caused”: If these were qualitative studies, as the authors note at the beginning of
this paragraph, or even non-experimental quantitative studies, causation cannot be inferred.
6. Line 292: “may”: Did they or didn’t they? If they did, the authors should use the modal verb
“can.”
7. Line 294: “The worse it was rated…”: There is an unclear referent.
8. Lines 295-206: What is this hypothesis based on?
9. Line 316-217: “However, such associations…” Can the authors include one or two reasons
why they think this might be?
10. Line 320: “cause”: See earlier comment about the use of the word “cause.”
11. Lines 328-329: “It reduces…” Could the authors please cite?
12. Lines 350-352: “The negative correlation…” Please cite.
13. Lines 380-381: “taboo topics”: Please cite.
14. Lines 381-382: “which contributes…” Please cite.
15. Lines 382-383: “Educational efforts…” Education alone has shown to be insufficient in
changing behavior. What else, in combination with education, can be implemented?
16. Lines 384-385: “Ultimately…” This statement is not supported by the data presented here.
17. Lines 401-403: “Moreover…” Was this data collected? If so, the authors should run a
subgroup analysis to see if there are differences in findings between those with a confirmed and
presumptive diagnosis.
18. Line 405: “Endometriosis research…” How is this relevant to this limitation? It should not
serve as an reason for not having conducted a dyadic survey.
19. Line 414-415: “implementing constructive communication patterns.” Could the authors
please specify what type of constructive communication would be most useful?