Volume 54, Issue 10, December 2025, 103048Author links open overlay panel, , , , , Section snippetsImaging-based diagnosis: a double-edged sword for generality

The authors correctly highlight the advantages of transvaginal ultrasound (TVU) and magnetic resonance imaging (MRI) over laparoscopy in diagnosis, citing their accessibility and reliability when used by experts with standardized protocols (e.g., IDEA). This approach is indeed valuable in the context of the study’s research question. However, focusing solely on imaging-confirmed moderate-to-severe cases introduces significant selection bias, limiting the generalizability of findings regarding

Interpreting "Non-significant" trends and "Older diagnosis"

The trend of reduced diagnostic delay (4.2 vs. 5.7 years, p > 0.05) post-NEPHP is interesting but not statistically significant. The authors’ hypothesis that "older diagnostic age reflects improved screening for previously undiagnosed cases" is plausible but needs scrutiny. First, the retrospective, monocentric design (focused on reproductive medicine referrals) provides no direct evidence that NEPHP increased screening or identified historical cases—factors like changed referral patterns or

Stark disparity: infertility vs. pain—systemic failure beyond accessibility

The study found a striking difference: diagnostic delay was much shorter for infertility (1.5 years) than for pain (6.9 years). The authors attribute this mainly to "better access to ART centers and specialized infertility networks," but this overlooks deeper systemic issues: persistent downplaying of pelvic pain and inadequate management in adolescents/young women.

Shorter delays in infertility reflect a system prioritizing fertility over quality of life and pain burden. While the authors note

Conclusion

Blandine Courbiere et al. provide important evidence of persistent diagnostic challenges in France post-NEPHP. Their focus on imaging-confirmed moderate-to-severe cases offers valuable insights but highlights gaps in SPE coverage and retrospective, monocentric limitations. The lack of significant improvement post-NEPHP, though possibly influenced by short-term evaluation and methodology, underscores the complexity of reducing delays. The large disparity between pain and infertility pathways

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Funding

This work is supported by the Natural Science Foundation of Jiangxi Province (20212ACB206014) and National Key R&D Program of China (2023YFC2508604).

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