Background:
Gonadal tissue cryopreservation provides fertility preservation for patients who cannot access established options such as sperm, oocyte or embryo cryopreservation. In Australia, access has historically been limited by the specialised surgical, laboratory and tissue-banking infrastructure required. The National Ovarian and Testicular Tissue Cryopreservation Service (NOTTCS) was established in 2019 to provide nationally coordinated ovarian and testicular tissue cryopreservation for adolescents and young adults aged 13-30 years. In 2024, the In Time National Paediatric Oncology Fertility Preservation Program was introduced to improve access for children, adolescents and young adults aged 0-24 years with cancer through education, referral coordination, and funded tissue transport and cryopreservation.
Aim:
To evaluate access to gonadal tissue cryopreservation within a nationally coordinated oncofertility network.
Methods:
Program data from NOTTCS and In Time were reviewed. Measures included fertility preservation referrals, tissue cryopreservation referrals and procedures, patient demographics, geographic distribution of referrals, and referral network development.
Results:
Between 2019 and 2026, 1,987 fertility preservation referrals were received, including 963 urgent referrals. Tissue cryopreservation accounted for 257 referrals (12.9% of all referrals; 26.7% of urgent referrals), with 173 patients proceeding to ovarian or testicular tissue cryopreservation. Forty percent of tissue preservation patients were younger than 16 years, demonstrating utilisation among patients with limited fertility preservation options. Referral pathways were established with 17 major hospitals nationally, including nine new referring hospitals, while 22% of referrals originated from rural or regional areas. Educational initiatives were associated with referrals from new patient cohorts at interstate paediatric oncology centres.
Conclusions:
A nationally coordinated oncofertility network combining centralised tissue processing, referral support and clinician education can facilitate equitable access to gonadal tissue cryopreservation across Australia. The integration of NOTTCS and In Time provides a scalable model for delivering fertility preservation care to paediatric, adolescent and young adult oncology patients regardless of geographic location.