Title: The Experiences of Fertility Concerns in Women with Inflammatory Bowel Disease of
Childbearing Age: A descriptive Qualitative study
Version: 0 Date: 10 Jan 2025
Reviewer's report:
This is a qualitative study assessing the fertility concerns of women of childbearing age with
inflammatory bowel disease through individual semi-structured interviews.
The introduction to the manuscript is lengthy and some of it could be moved to the discussion
but the literature cited is appropriate and relevant to the research question.
Sampling was not ideally performed as it is biased by having been performed by one clinician
who identified eligible patients, invited them to participate and consented them for the study
which can introduce both sampling bias and risk of coercion due the consenting being performed
by a health care provider.
The methods section does not include how many patients were approached to participate in
the study but declined to participate nor what the population of patients with IBD is and this
information should be included if possible.
The inclusion criteria stated that they included patients who had not yet given birth, yet Table
1 shows that 2 patients had given birth and the last quote order Theme 3 speaks of a daughter
entering first grade (which admittedly could be an adopted child but now I am suspicious this is
not so), so this cannot be accurate inclusion criteria and should be addressed within the text why
these women were included when it was explicitly stated that they were only included women
who had not given birth. Within the inclusion criteria they state they would include patients who
"had recently (within the past year) planned to conceive" which is an odd statement to have on
the same line as  those who had not given birth as they seem to be different concepts. Perhaps
the wording of this inclusion criteria is incorrect and was not translated properly in which case it
needs to be fixed to reflect what the actual inclusion criteria were although I think it is reasonable
to have women who both had and do not have children included int he study, it does change the
nature of the interpretation of the results if it was only women who have not had children who
were sampled. Similarly, does this mean that some of the participants in the study were also
pregnant at the time of the interview and if so, that should be added to Table 1. As attempting
pregnancy is actually quite an important point, it should be added to Table 1 if these women
had attempted to conceive or not if that information is known since it was part of the inclusion
criteria, it suggests that it should be known.
It is stated that the interviews were conducted in Mandarin. How was translation performed
and checked and when ie. at the time of manuscript preparation or shortly after interviews were
performed ,and when patients were able to review their thematic coding, was this in Mandarin
or English language?
Results: the themes are well described with well selected quotes.
It would be nice if the discussion section included some discussion about the rate of anxiety that
women of reproductive age who do not have IBD feel about fertility and pregnancy to highlight
whether these are common concerns among all reproductive age women or unique to the IBD
patient population.
Overall, this paper covers an important topic and adds these patient voices to the  minimal
literature on fertility concerns for women with IBD.
Title: The Experiences of Fertility Concerns in Women with Inflammatory Bowel Disease of
Childbearing Age: A descriptive Qualitative study
Version: 0 Date: 10 Jan 2025
Reviewer's report:
This is a qualitative study assessing the fertility concerns of women of childbearing age with
inflammatory bowel disease through individual semi-structured interviews.
The introduction to the manuscript is lengthy and some of it could be moved to the discussion
but the literature cited is appropriate and relevant to the research question.
Sampling was not ideally performed as it is biased by having been performed by one clinician
who identified eligible patients, invited them to participate and consented them for the study
which can introduce both sampling bias and risk of coercion due the consenting being performed
by a health care provider.
The methods section does not include how many patients were approached to participate in
the study but declined to participate nor what the population of patients with IBD is and this
information should be included if possible.
The inclusion criteria stated that they included patients who had not yet given birth, yet Table
1 shows that 2 patients had given birth and the last quote order Theme 3 speaks of a daughter
entering first grade (which admittedly could be an adopted child but now I am suspicious this is
not so), so this cannot be accurate inclusion criteria and should be addressed within the text why
these women were included when it was explicitly stated that they were only included women
who had not given birth. Within the inclusion criteria they state they would include patients who
"had recently (within the past year) planned to conceive" which is an odd statement to have on
the same line as  those who had not given birth as they seem to be different concepts. Perhaps
the wording of this inclusion criteria is incorrect and was not translated properly in which case it
needs to be fixed to reflect what the actual inclusion criteria were although I think it is reasonable
to have women who both had and do not have children included int he study, it does change the
nature of the interpretation of the results if it was only women who have not had children who
were sampled. Similarly, does this mean that some of the participants in the study were also
pregnant at the time of the interview and if so, that should be added to Table 1. As attempting
pregnancy is actually quite an important point, it should be added to Table 1 if these women
had attempted to conceive or not if that information is known since it was part of the inclusion
criteria, it suggests that it should be known.
It is stated that the interviews were conducted in Mandarin. How was translation performed
and checked and when ie. at the time of manuscript preparation or shortly after interviews were
performed ,and when patients were able to review their thematic coding, was this in Mandarin
or English language?
Results: the themes are well described with well selected quotes.
It would be nice if the discussion section included some discussion about the rate of anxiety that
women of reproductive age who do not have IBD feel about fertility and pregnancy to highlight
whether these are common concerns among all reproductive age women or unique to the IBD
patient population.
Overall, this paper covers an important topic and adds these patient voices to the  minimal
literature on fertility concerns for women with IBD.
Please review this paper.
user
Title: The Experiences of Fertility Concerns in Women with Inflammatory Bowel Disease of
Childbearing Age: A descriptive Qualitative study
Version: 0 Date: 10 Jan 2025
Reviewer's report:
This is a qualitative study assessing the fertility concerns of women of childbearing age with
inflammatory bowel disease through individual semi-structured interviews.
The introduction to the manuscript is lengthy and some of it could be moved to the discussion
but the literature cited is appropriate and relevant to the research question.
Sampling was not ideally performed as it is biased by having been performed by one clinician
who identified eligible patients, invited them to participate and consented them for the study
which can introduce both sampling bias and risk of coercion due the consenting being performed
by a health care provider.
The methods section does not include how many patients were approached to participate in
the study but declined to participate nor what the population of patients with IBD is and this
information should be included if possible.
The inclusion criteria stated that they included patients who had not yet given birth, yet Table
1 shows that 2 patients had given birth and the last quote order Theme 3 speaks of a daughter
entering first grade (which admittedly could be an adopted child but now I am suspicious this is
not so), so this cannot be accurate inclusion criteria and should be addressed within the text why
these women were included when it was explicitly stated that they were only included women
who had not given birth. Within the inclusion criteria they state they would include patients who
"had recently (within the past year) planned to conceive" which is an odd statement to have on
the same line as  those who had not given birth as they seem to be different concepts. Perhaps
the wording of this inclusion criteria is incorrect and was not translated properly in which case it
needs to be fixed to reflect what the actual inclusion criteria were although I think it is reasonable
to have women who both had and do not have children included int he study, it does change the
nature of the interpretation of the results if it was only women who have not had children who
were sampled. Similarly, does this mean that some of the participants in the study were also
pregnant at the time of the interview and if so, that should be added to Table 1. As attempting
pregnancy is actually quite an important point, it should be added to Table 1 if these women
had attempted to conceive or not if that information is known since it was part of the inclusion
criteria, it suggests that it should be known.
It is stated that the interviews were conducted in Mandarin. How was translation performed
and checked and when ie. at the time of manuscript preparation or shortly after interviews were
performed ,and when patients were able to review their thematic coding, was this in Mandarin
or English language?
Results: the themes are well described with well selected quotes.
It would be nice if the discussion section included some discussion about the rate of anxiety that
women of reproductive age who do not have IBD feel about fertility and pregnancy to highlight
whether these are common concerns among all reproductive age women or unique to the IBD
patient population.
Overall, this paper covers an important topic and adds these patient voices to the  minimal
literature on fertility concerns for women with IBD.
assistant