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After revisions, all reviewers agreed to publish the manuscript. I also reviewed the manuscript and found no obvious risks to publication. Therefore, I also approved the publication of this manuscript.
Language: The manuscript is written in clear and professional English.
Structure: The manuscript generally follows the standard structure for a research article.
Referencing: The literature is well-referenced.
Figures: The figures are relevant and adequately labeled. The quality could be improved slightly for publication.
Raw data: The raw data is provided, which is commendable and enhances the transparency and reproducibility of the research.
Originiality: The study investigates a relevant and meaningful reserach question regarding the predictive value of peri-trigger FRH trends in oocyte maturation, addressing a gap in current knowledge.
Methodology: The methodology is generally sound.
Statistical Analysis: The statistical analysis is appropriate, employing univariable and multivariable logistic regression. The use of C-indices and ROC curves further validates the predictive ability of the model.
The data appears robust and supports the main conclusions. The authors acknowledge limitations, such as the retrospective design and potential for confounding factors.
Conclusions: The conclusions are well-stated and linked to the original research question. They are appropriately limited to the findings of the study, emphasizing the need for further research to confirm the results and explore clinical applications.
This study provides valuable insights into the potential role of peri-trigger FRH trends, particularly P_RoV2, as predictors of maturation in normal ovarian reserve patients. The findings warrant further investigation and could potentially contribute to the optimization of IVF-ET protocols.
Recommended revisions have been made. The manuscript can be edited according to editor's decision.
Appropriate
Appropriate
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The authors are requested to carefully revise the manuscript and answer the questions raised by the reviewers.
Overall, the basic reporting of the manuscript is strong, but there is room for improvements in the introduction and methods sections for better clarity and context.
1. Introduction: The introduction could be strengthened by providing a more detailed explanation of the knowledge gap that the study aims to fill. While it mentions the limitations of existing prediction models, it could explicitly state how this study addresses those limitations.
2. Methods: The method for categorizing delta-FRHs could be explained in more detail. The authors mention the lack of established standards but could further elaborate on the rationale behind their chosen categorization method and its potential limitations.
3. Results: The results section could benefit from a more concise presentation of the findings. Some of the details could be moved to supplementary materials or appendices.
Overall, the experimental design is appropriate for addressing the research question, but the retrospective nature and limitations in generalizability should be considered when interpreting the findings.
1. Retrospective nature: The retrospective design has inherent limitations, such as potential selection bias and the inability to control for confounding variables as effectively as in a prospective study.
2. Sample size: While the sample size is reasonable, it may not be sufficient for subgroup analyses, especially for less frequent categories of delta-FRHs. This is acknowledged by the authors as a limitation.
3. Generalizability: The study population consists of patients with normal ovarian reserve, which may limit the generalizability of the findings to other patient groups, such as those with diminished ovarian reserve or PCOS. The authors acknowledge this limitation.
4. Control group: The study lacks a true control group. Comparing HMRG and LMRG provides some insights, but a comparison with a group not undergoing IVF-ET would strengthen the conclusions.
Overall, the findings of the study are valid and provide valuable insights into the potential role of peri-trigger FRHs, especially P_RoV2, in predicting oocyte maturation. However, the limitations of the study design and potential confounding variables should be considered when interpreting the results and drawing causal inferences.
1. Confounding variables: While the authors controlled for some potential confounders in the multivariable analysis, there may be other unmeasured variables that could influence the relationship between peri-trigger FRHs and oocyte maturation.
2. Subgroup analysis: The small sample size in some subgroups, particularly in the high P_RoV2 category of the GnRH-agonist group, raises concerns about the reliability of the results for these specific groups.
3. Causal inference: The study design allows for establishing associations but cannot prove a causal relationship between peri-trigger FRHs and oocyte maturation.
While the overall methodology and analysis appear sound, a few potential issues require clarification or further consideration:
1. Categorization of Delta-FRHs: The method for categorizing delta-FRHs as "low," "intermediate," and "high" is not clearly explained and lacks a strong rationale. As the authors mention, there are no established standards for this categorization. Using arbitrary cut-offs could potentially influence the results and limit the interpretability of the findings. Exploring alternative categorization methods or providing a more robust justification for the chosen approach would strengthen the analysis.
2. Exclusion of LH_RoV: The authors mention excluding LH_RoV due to the potential impact of the triggering protocol on serum LH levels. However, it's unclear why this would only affect post-trigger LH levels and not baseline or trigger day levels. Further clarification is needed on the rationale for excluding LH_RoV entirely from the analysis.
3. Potential confounding variables: While the multivariable analysis controlled for some potential confounders, other factors might influence both peri-trigger FRH levels and oocyte maturation. These could include:
(1) Body mass index (BMI): BMI is known to affect reproductive hormone levels and IVF outcomes.
(2) Cause of infertility: Different causes of infertility might have varying impacts on oocyte quality and hormone levels.
(3) Specific medications used during ovarian stimulation: Different types and dosages of medications could influence hormonal responses and oocyte development.
Addressing these potential issues would strengthen the validity and reliability of the study's findings.
The authors have made revisions partly. However the tables and figure shall be explained by legends in more detail.
Adequate
Adequate
The authors are requested to carefully revise the manuscript and answer the questions raised by the reviewers.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
This study aimed to assess the effectiveness of peri-trigger female reproductive hormones (FRHs) in predicting oocyte maturation during in vitro fertilization-embryo transfer (IVF-ET) in patients with normal ovarian reserve. The research utilized a hospital database and analyzed data from IVF-ET cases between January 2020 and September 2021. The levels of female reproductive hormones including estradiol (E2), luteinizing hormone (LH), progesterone (P), and follicle-stimulating hormone (FSH) were evaluated at different time points. The relative change in hormone levels between these time points was calculated. Univariable and multivariable regression analyses were conducted to identify potential predictors for oocyte maturation.
There are a few point-by-point comments for authors to revise the manuscript accordingly.
Authors need to rewrite the Introduction, which lacks informativeness and fails to introduce research question, objective and previous relevant studies. Authors may consider incorporating some information from Discussion (Lines 229-245) into the Introduction to provide context and enhance its comprehensiveness. Lines 1-2 were not well written and hard to understand.
The writing in the second and third subsections of the Results section needs improvement. The description of major findings is difficult for readers to follow. Clarifying the language and structure of these sections would enhance readability and comprehension for readers.
In line 135, authors mentioned the two-sided test, but it remains unclear which hypothesis testing was employed. Authors should provide clarification regarding the specific statistical analysis implemented. Additionally, it is worth noting that in statistics, there are both one-tailed and two-tailed tests.
In line 225, there is a typo. Further research is needed to investigate the relationship.
The inclusion and exclusion criteria require refinement. Authors should consider adding abnormal ovarian function as an exclusion criterion.The inclusion and exclusion criteria require refinement. Authors should consider adding abnormal ovarian function as an exclusion criterion.
The major findings and conclusions in the Results section are unclear. Authors should consider revising the subsection titles in the results section to make them more informative and reflective of the significant findings.
The Conclusions section lacks informativeness. Authors should incorporate major findings into the conclusion section to enhance clarity.
-The Introduction part (lines 51-65) is insufficient. The authors shall explain the topic and aim of the manuscript in more detail.
- The authors shall add reference in line 80 (ovarian stimulation methods).
- What does the authors mean by 'Direct stimulation protocol' (line 82).
- The discussion part is insufficient. The findings shall be discussed in more details and with more references.
- The ethics number of the research has to be written in detail.
- Table and figure subtitles have to be written in detail and statistical findings shall be written in them.
- The experimental design is appropriate.
- The findings are valid and appropriate.
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