Relationship between Ovarian Reserve Markers and Body Mass Index in Infertile Women with and without Polycystic Ovary Syndrome: A Retrospective Case–Control Study
Round 1
Reviewer 1 Report (Previous Reviewer 2)
I commend the authors for carrying out this study and the revisions made after the first submission. The statistical analysis breakdown greatly enhanced the findings made. I would like to point out a few observations: (1) The abstract is short and could accommodate some more information. For instance some of the age-related findings which could aid further research works. (2) I noticed a grammatical error- Moreover, any correlation was found between BMI and hormonal 372 parameters of ovarian reserve irrespective of the presence of OD
Comments for author File: 
Comments.pdf
The English style is fine, with minor corrections to be made.
Author Response
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Author Response File: Author Response.pdf
Reviewer 2 Report (New Reviewer)
Despite much research, questions about this topic keep coming back to us. This exciting article nicely explains the possible connections between obesity, age and ovarian reserve.
I have some comments and questions.
1. It is necessary to review the entire text, as the paragraphs are written in black and red. Please convert everything to black.
2. Please correct the design of Tables 4 and 5.
3. Waist circumference measurement is one of the criteria for metabolic syndrome, but it is not specified in the methods. Please add or argue why it is not stated.
4. I wonder why the sub-analysis of the second group was done on patients younger than 37 years old. Why did the authors choose this age?
5. In chapter 2.1, the number of patients (N) in each group A, B, C, and D could be listed.
6. How do the authors comment on the age difference between groups 1 and 2? Could we explain this by saying that patients with PCOS have more problems and visit the doctor earlier? Or do they anticipate that the fertilization process will be longer due to a known illness? Or does it take so long to diagnose a non-PCOS cause of infertility?
Author Response
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This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
Manuscript ID: reprodmed-2067764
Title: Relationship between ovarian reserve markers and body mass index in infertile women with and without polycystic ovary syndrome: a retrospective case-control study
Authors: Luisa Casadei, Ilaria Nacci , Veronica Vicomandi , Roberto Pietro Sorge , Carlo Ticconi
In this retrospective case-control study on a cohort of infertile women with and without PCOS, the authors investigated the relationship between BMI and a selected panel of ovarian hormonal reserve (AMH, FSH, LH, and E2) stratified by age and BMI. The authors reported a negative correlation between BMI and serum LH irrespective of the OD status of these women and have unveiled a lack of association between BMI and the tested ovarian hormonal reserve. Moreover, the authors believe the age rather than BMI had a major influence on their statistical outcomes.
Major concerns:
The major concern of this reviewer is that the author's use of the multivariate analysis might have masked the propensity of data and the actual effect of the BMI on the ovarian hormonal reserve parameters in individual age groups resulting in an ambiguous interpretation. This becomes a very valid concern in view of the authors’ presently reported outcome showing that BMI, and not age, did indeed negatively influence FSH levels irrespective of OD in their sample population. Please reconsider your assessment of the lack of statistical influence of BMI on serum FSH by examining the influence of age and BMI on hormonal reserve among subgroups A1-D1 and A2-D2 in a Univariate context (e.g., running multiple t-tests comparing the individual group means amongst groups A1-D1 and a similar analysis of groups A2-D2 to ascertain the potential influence of BMI on the ovarian hormonal reserve in these subgroups). Pearson correlation analysis should also be conducted in a similar manner in assessing the influence of age and of BMI on the hormonal reserve in individual subgroups A1-D1 and A2-D2 (performing correlation analysis on the entire population (n=94 and n=102) might have masked data propensity). Please reconsider your discussion and conclusions accordingly.
Author Response
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Reviewer 2 Report
The paper is very relevant and of immense interest to researchers in reproductive medicine and lay readers readers as well, given the rise in infertility globally.
There were some plagiarized text in the manuscript.
It appears the results of table 2 does not synchronize with the conclusions from this study.
The authors position is that BMI has no effect on the reproductive parameters investigated, but age does.
The results in table 2 appears not to be in consonance with this finding.
A break down of the data showed that D1, D2 and B1 have very high SD; which implies there is much disparity in the data sets. This is evident from AMH and LH, in some cases over 50% deviation.
Secondly, Between C1 and D1 with the exception of AMH, all the parameters are higher in C1 than in D1, yet BMI <25. Similar findings occurred between C2 and D2.
LH is significant across the groups.
Further observation is that in comparing A1 and B1; for Estradiol, There seems to be a BMI effect. Similar comparison of A2 and B2 is inconclusive possibly due to the sample size. If taken as it is, then BMI has an effect on estradiol parameter for women without PCO.
From the results presented; BMI does have an effect for >35 years.
Comments for author File: Comments.pdf
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
- Previous concerns were not addressed, and no justifications for the new edits were provided.
