(95) Ovarian Tissue Cryopreservation in Pediatric Centers Across the United States: Practice Patterns and Barriers

Background: Evaluate practice patterns in ovarian tissue cryopreservation (OTC) provision in pediatric, adolescent and young adult (AYA) populations.

Methods: United States providers practicing or developing OTC programs were invited to participate in a survey disseminated via the Oncofertility Consortium.

Results: Twenty-eight programs representing a wide geographic area responded, largely representing academic institutions (85.7%). Of these, 22 (78.6%) perform OTC at their facility. Primary involved parties in fertility preservation counseling were fertility patient navigators (86.2%), gynecologists (63.6%) and treating oncologists (36.4%). Most centers perform OTC for oncology patients receiving gonadotoxic therapy, relapsed patients and non-oncologic patients receiving gonadotoxic therapy (95.8, 87.5, 83.3% respectively). However, practices for lower risk and non-oncologic populations were variable with OTC less commonly completed for patients with ‘moderate’ gondadotoxic risk therapy, Turner Syndrome, differences of sex development and gender dysphoria (71.4, 29.2, 20.8, 16.7% respectively). Most programs (68.8%) refer patients to outside facilities when OTC was not offered in the patient population. Most (63.6%) perform OTC as standard of care, 31.8% with an IRB-approved research protocol, and 4.5% with a mixed approach. Of those performing exclusively standard of care OTC, 57.1% utilize an IRB for data collection. Surgeons performing OTC are most commonly pediatric gynecology surgeons (72.7%), followed by pediatric general surgeons (63.6%) and adult gynecology surgeons (13.6%). The most common surgical method was laparoscopic oophorectomy (90.9%) using an electro-thermal bipolar (33.3%) or ultrasonic instrument (23.8%) for dissection. The majority of centers reported using an outside compensated service (52.4%) or an REI group (42.9%) for processing tissue. Of the 8 centers whose OTC programs are in the planning or early stages, common barriers were lack of priority within their institutions or lack of protected time (both 37.5%) and lack of funding or resources to process ovaries (both 12.5%). Of those who referred for OTC, the majority (5/7, 85.7%) ask patients to travel over 50 miles and 1 (14.2%) over 200 miles, with 42.9% having funding.

Conclusions: OTC is commonly offered for high risk AYA oncology patients with gynecologists frequently involved in counseling and performing OTC. Variability exists in offering OTC to other patient populations, as well as in surgical technique and processing. Institutions continue to face barriers to offering OTC when necessary resources are not prioritized by leadership.