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This article is acceptable for publication but please consider the minor revisions suggested by the reviewer.
[# PeerJ Staff Note: Although the Academic Editor is happy to accept your article as being scientifically sound, a final check of the manuscript shows that it would benefit from further editing. Therefore, please identify necessary edits and address these while in proof stage. #]
The manuscript has undergone major revision. The authors have provided robust responses and improved the quality of the manuscript.
Good retrospective study with large patient population.
It is a well written study with good statistical analysis and the authors have explained the study result and the impact of the elevated estradiol on various embryonic stage transfers.
I have attached the PDF with few minor changes in the manuscript.
no comment
no comments
no comment
Editor notes and agrees with the review’s concerns. Additional concerns and comments are listed below;
Please clarify if the experimental design of this study includes mixed data from embryos that originated from IVF or ICSI or both. It is not clear in the materials and methods.
The embryology protocols are missing such as the insemination method, culture conditions, media used, fertilization rate, embryo grades, etc.
What was the reason for cleavage stage embryo transfers? Please explain this in the limitations.
Male factor is neglected in this study. There are not any sperm parameters mentioned. Were testicular sperm or ejaculated sperm used for the procedures?
What are the sperm concentration, motility, and morphology of males within groups?
English editing is needed.
This manuscript should be revised extensively and the statistical analysis must be redone by removing the biased data before resubmission.
Best Regards
[# PeerJ Staff Note: Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. #]
[# PeerJ Staff Note: The Academic Editor has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at copyediting@peerj.com for pricing (be sure to provide your manuscript number and title) #]
no comment
E2 over 3354pg/ml or 3500 pg/ml were believed to highly indicated of OSHH, but the article did not mention possible pathophysiological impact of OSHH on pregnancy, and possible lead to low CPR of set 4 vs. set 1.
Even though severe OSHH was excluded, the author did not clearly state the criteria of exclusion.
In the discussion part, did not discuss thoroughly the reason of set 4 of cleavage stage CPR was not impacted by high E2 level.
no comments
The manuscript is prepared with good structure. However an English editor can improve English structure and grammar of the manuscript
The downside is that the study is retrospective review. Its is doubtful that in the present clinical scenario the study has much relevance.
The authors need to provide the reasons and evidence for the relevance of the study.
Findings have been provided with good statistical analysis. Why the high Estradiol levels had no deleterious effects on early cleavage stage embryos?
The study design was not robust as it was a retrospective study.
The authors need to explain and provide reasons for higher CPR obtained with the early fresh cleavage stage transfers vs blastocyst transfer. Also the authors can provide the evidence of any similar studies published in literature supportive of their findings/
Please provide conclusions on the clinical impact of the paper and whether it changes any practice guidelines.
Please explain in the current scenario how does the study impact IVF practice when most IVF centers are performing frozen blastocysts transfers.
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