Many, if not all, authors have experienced rejection of a submitted manuscript. As an author myself, I have also had some of my manuscripts rejected by a variety of journals. Even worse, in a few instances and only after many revisions and resubmissions to the same journal, the editorial team finally stated that my manuscript was not suitable for the journal! At the beginning of my career, rejection made me upset, frustrated, angry, and discouraged. But actually, there are many reasons why a manuscript is rejected. After serving as an associate editor for specialty and subspecialty journals and as a member of the editorial board of several peer-reviewed journals, I now have a much better understanding of how decisions on the fate of a manuscript are made. In fact, as authors, recognizing the reasons leading to a rejection allows us to improve the manuscript and improves the chance for future publication. An editor's decision to accept or reject a manuscript is based mostly on the comments of the reviewers. Typically, the opinions of the reviewers are generally similar, and we rarely encounter opposing views. In such cases, however, we would seek another opinion from an adjudicating reviewer. Remember too, that often reviewers do not state their major reservations in their comments to the authors but do mention them in a confidential note to the editor. There are many reasons why a manuscript is rejected. Here are some examples:•The material in the manuscript is beyond the scope of the journal. For instance, a manuscript related to basic science investigation with minimal clinical implications would not be suitable for a clinical journal; similarly, manuscripts dedicated to pathology, psychology, etc. with minimal implications for obstetrics and gynaecology would not be suitable for the JOGC.•The manuscript is not novel and provides no or minimal new information to the literature. For example, a manuscript on a study that has been done elsewhere but has never been done in Canada does not make it novel, nor would a manuscript on the use of robotic assistance for a given procedure be considered novel because it is more or less similar to a laparoscopic approach.•The manuscript doesn't follow the journal's instructions for authors or is incomplete, unintelligible, or poorly written. Although these situations do not lead to immediate rejection, the manuscript will be returned to the authors to be rewritten.•The editorial office team has detected plagiarism or a duplicate publication. The team evaluates all submissions for possible plagiarism, which will lead to automatic rejection. Or the team may discover that the authors have published a similar article in English or in another language. Plagiarism and duplicate publications are a violation of ethics in scholarly publishing.•The study does not provide scientific value, is poorly performed, contains flaws, is biologically implausible, has poorly described procedures or methods, contains incorrect statistical analyses, or contains a small sample size or low survey response rate.•Images of the month submissions contain images that are common, poor quality or esthetically unacceptable. What can authors do?•Appeal the journal's decision. However, unless due process was not followed, the reviewers made a serious error in judgement, or the decision was based on a factual error, appeal is rarely successful.•Improve the manuscript based on the reviewers’ suggestions and comments and submit it to the best-fit journal for your manuscript. Remember too that a reviewer for one journal may also be a reviewer for another journal. So, without addressing the initial reviewers’ comments, you may find yourself with another rejection.•Submit your manuscript to a journal whose focus matches your submission. The priorities for the JOGC, for example, are quantitative research and systematic reviews and meta-analyses. Early in my career, I buried a manuscript that had been rejected by a journal and never resubmitted it. That was an irrational decision that I eventually regretted: a few years later, I found that a similar study had been published in a high impact journal. Today, I realize that most manuscripts that are initially rejected can eventually be published in a suitable journal for that particular submission, following major revisions or a complete rewrite as necessary. A journal's editorial team recognizes the considerable time and effort needed to conduct a study and to write a manuscript. Editorial decisions are not taken lightly. We consider many factors, including the quality of the manuscript, the journal's readership, and the need to balance recent or upcoming accepted papers with new submissions. By putting the necessary effort into preparing your manuscript and selecting the most appropriate journal for your work, you can improve the likelihood of getting your work published in a timely manner.