Peer Review History

Original SubmissionJuly 26, 2022
Decision Letter - Diego Raimondo, Editor

PONE-D-22-21031Endometriosis and pregnancy: the illusion of recovery.PLOS ONE

Dear Dr. Netter,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: I read with great interest the manuscript, which falls within the aim of this Journal. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Nevertheless, the authors should clarify some points and improve the discussion, as suggested below.

Authors should consider the following recommendations:

- Manuscript should be further revised in order to correct some typos and improve style.

- I would suggest to discuss, at least briefly, the results from the SAFE (surgery and ART for endometriomas) trial, and in general of the integrated approach (surgery + ART) aimed to improve reproductive outcomes in women with endometriosis-associated infertility (PMID: 34585638; PMID: 29274003).

- Authors should discuss the detrimental role of infertility associated with endometriosis on psychological wellbeing (they may refer to: PMID: 27750472; PMID: 26319653).

Reviewer #2: thank you to give me tha chence to revie this qualitative study on the illusion of recovery during pregnancy involving patients affected by endometriosis. The study is well conducted and explored a very important topic giving new insights to medical literature. It can help counselling patients in our outpatient clinics.

I suggest only to revise english language throughout the manuscript and add relevant and specific literature regarding the medical therapy adopted to treat deep lesions (doi 10.1016/j.jmig.2011.04.008) focusing on the importance to suggest medical therapy also after delivery.

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Reviewer #1: No

Reviewer #2: No

**********

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Revision 1

Reviewer #1: I read with great interest the manuscript, which falls within the aim of this Journal. In my honest opinion, the topic is interesting enough to attract the readers’ attention. Nevertheless, the authors should clarify some points and improve the discussion, as suggested below.

Response: We thank reviewer #1 for his/her comments.

Authors should consider the following recommendations:

- Manuscript should be further revised in order to correct some typos and improve style.

Response: The reviewer is right, there was a need to review the English. We did a full proofreading and editing throughout the manuscript to improve the style and syntax. We also commissioned scribbr to validate this proofreading (https://www.scribbr.fr/). We enclose the invoice as an additional document as proof. We hope the result will be satisfactory. Nevertheless, we know that these proofreading companies are not foolproof. If the reviewer finds any errors that have escaped our attention, we will gladly correct them.

- I would suggest to discuss, at least briefly, the results from the SAFE (surgery and ART for endometriomas) trial, and in general of the integrated approach (surgery + ART) aimed to improve reproductive outcomes in women with endometriosis-associated infertility (PMID: 34585638; PMID: 29274003).

Response: The reviewer is right: these data from the literature are important and relevant to our topic. We have added a paragraph to the discussion integrating the literature suggestions of both reviewers:

Our study focuses on infertile women who have undergone IVF and achieved pregnancy. Some data in the literature have already established that endometriosis and endometriosis-induced infertility have a negative impact on quality of life [17,18]. The qualitative data we present allow us to explore the changes that take place precisely when infertility treatments have worked, and patients are pregnant. Our results are indeed in favor of an improvement during the pregnancy following IVF but suggest that this improvement is only temporary. Only quantitative data based on questionnaires should clarify whether quality of life is durably improved after pregnancy, but our results do not seem to suggest this. The interviews deliberately address very little about surgical treatment, even though most of our patients had undergone surgery prior to IVF according to an integrated approach already described in the literature [19,20]. It is likely that this integrated approach for endometriosis-associated infertility has an impact that should be explored to determine which of surgery or IVF has the greatest influence on patient experience. Several of our results also showed how these changes in patients' experiences make it difficult to resume hormone treatment after pregnancy. Several data in the literature suggest that this treatment is important to reduce the symptoms and progression of endometriosis [5,21]. Our study highlights the need to better inform patients of the importance of this medical treatment after childbirth even in the absence of symptoms.

17. Ban Frangež H, Vrtacnik Bokal E, Štimpfel M, Divjak Budihna T, Gulino FA, Garzon S, et al. Reproductive outcomes after laparoscopic surgery in infertile women affected by ovarian endometriomas, with or without in vitro fertilisation: results from the SAFE (surgery and ART for endometriomas) trial. J Obstet Gynaecol. 2022;42: 1293–1300. doi:10.1080/01443615.2021.1959536

18. Šalamun V, Verdenik I, Laganà AS, Vrtačnik-Bokal E. Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis. Arch Gynecol Obstet. 2018;297: 613–621. doi:10.1007/s00404-017-4633-0

- Authors should discuss the detrimental role of infertility associated with endometriosis on psychological wellbeing (they may refer to: PMID: 27750472; PMID: 26319653).

Response: The reviewer is right: these data from the literature are important and relevant to our topic. We have added a paragraph to the discussion integrating the literature suggestions of both reviewers:

Our study focuses on infertile women who have undergone IVF and achieved pregnancy. Some data in the literature have already established that endometriosis and endometriosis-induced infertility have a negative impact on quality of life [17,18]. The qualitative data we present allow us to explore the changes that take place precisely when infertility treatments have worked, and patients are pregnant. Our results are indeed in favor of an improvement during the pregnancy following IVF but suggest that this improvement is only temporary. Only quantitative data based on questionnaires should clarify whether quality of life is durably improved after pregnancy, but our results do not seem to suggest this. The interviews deliberately address very little about surgical treatment, even though most of our patients had undergone surgery prior to IVF according to an integrated approach already described in the literature [19,20]. It is likely that this integrated approach for endometriosis-associated infertility has an impact that should be explored to determine which of surgery or IVF has the greatest influence on patient experience. Several of our results also showed how these changes in patients' experiences make it difficult to resume hormone treatment after pregnancy. Several data in the literature suggest that this treatment is important to reduce the symptoms and progression of endometriosis [5,21]. Our study highlights the need to better inform patients of the importance of this medical treatment after childbirth even in the absence of symptoms.

19. Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS. Impact of endometriosis on quality of life and psychological well-being. J Psychosom Obstet Gynaecol. 2017;38: 317–319. doi:10.1080/0167482X.2016.1244185

20. Laganà AS, Condemi I, Retto G, Muscatello MRA, Bruno A, Zoccali RA, et al. Analysis of psychopathological comorbidity behind the common symptoms and signs of endometriosis. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2015;194: 30–33. doi:10.1016/j.ejogrb.2015.08.015

Reviewer #2: thank you to give me the chance to review this qualitative study on the illusion of recovery during pregnancy involving patients affected by endometriosis. The study is well conducted and explored a very important topic giving new insights to medical literature. It can help counselling patients in our outpatient clinics.

Response: We thank reviewer #2 for his/her remarks.

I suggest only to revise english language throughout the manuscript and add relevant and specific literature regarding the medical therapy adopted to treat deep lesions (doi 10.1016/j.jmig.2011.04.008) focusing on the importance to suggest medical therapy also after delivery.

Response: The reviewer is right, there was a need to review the English. We did a full proofreading and editing throughout the manuscript to improve the style and syntax. We also commissioned scribbr to validate this proofreading (https://www.scribbr.fr/). We enclose the invoice as an additional document as proof. We hope the result will be satisfactory. Nevertheless, we know that these proofreading companies are not foolproof. If the reviewer finds any errors that have escaped our attention, we will gladly correct them.

The reviewer is right: these data from the literature are important and relevant to our topic. We have added a paragraph to the discussion integrating the literature suggestions of both reviewers:

Our study focuses on infertile women who have undergone IVF and achieved pregnancy. Some data in the literature have already established that endometriosis and endometriosis-induced infertility have a negative impact on quality of life [17,18]. The qualitative data we present allow us to explore the changes that take place precisely when infertility treatments have worked, and patients are pregnant. Our results are indeed in favor of an improvement during the pregnancy following IVF but suggest that this improvement is only temporary. Only quantitative data based on questionnaires should clarify whether quality of life is durably improved after pregnancy, but our results do not seem to suggest this. The interviews deliberately address very little about surgical treatment, even though most of our patients had undergone surgery prior to IVF according to an integrated approach already described in the literature [19,20]. It is likely that this integrated approach for endometriosis-associated infertility has an impact that should be explored to determine which of surgery or IVF has the greatest influence on patient experience. Several of our results also showed how these changes in patients' experiences make it difficult to resume hormone treatment after pregnancy. Several data in the literature suggest that this treatment is important to reduce the symptoms and progression of endometriosis [5,21]. Our study highlights the need to better inform patients of the importance of this medical treatment after childbirth even in the absence of symptoms.

21. Mabrouk M, Frascà C, Geraci E, Montanari G, Ferrini G, Raimondo D, et al. Combined oral contraceptive therapy in women with posterior deep infiltrating endometriosis. J Minim Invasive Gynecol. 2011;18: 470–474. doi:10.1016/j.jmig.2011.04.008

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Diego Raimondo, Editor

Endometriosis and pregnancy: the illusion of recovery.

PONE-D-22-21031R1

Dear Dr. Netter,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Diego Raimondo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Diego Raimondo, Editor

PONE-D-22-21031R1

Endometriosis and pregnancy: the illusion of recovery.

Dear Dr. Netter:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Diego Raimondo

Academic Editor

PLOS ONE

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