Geographic patterns of ovarian tissue cryopreservation utilisation across age groups in a nationwide multicentre cohort
Norah L A Emrich, Rebekka Einenkel, Cara M Färber, Andreas Schallmoser, Nicole SängerAbstract
STUDY QUESTION
Does geographic proximity to a centralised cryobank reflect age-dependent differences in ovarian tissue cryopreservation (OTC) utilisation?
SUMMARY ANSWER
Paediatric patients resided significantly closer to the cryobank than adolescents and adult women, suggesting age-dependent geographic differences in the utilisation of fertility preservation services.
WHAT IS KNOWN ALREADY
OTC is an established fertility preservation option, and previous studies have primarily focused on return rates of cryopreserved ovarian tissue and subsequent pregnancy and live birth outcomes. However, less is known about utilisation patterns of fertility preservation, particularly for OTC in paediatric oncology, where utilisation may be influenced by factors such as clinician-initiated counselling and local referral pathways.
STUDY DESIGN, SIZE, DURATION
This retrospective nationwide multicentre cohort study included 2,426 patients referred from 124 centres who underwent OTC at a central cryobank between 2000 and 2021.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Patients were stratified into children (<15 years, n = 149), adolescents (15–19 years, n = 296), and adults (≥20 years, n = 1,981). Residential addresses were geocoded, and distances to the cryobank were calculated. Regional distribution was categorised by population size. Statistical analyses included Chi-square and non-parametric tests with Bonferroni correction.
MAIN RESULTS AND THE ROLE OF CHANCE
Median distance to the cryobank increased with age (children: 136 km; adolescents: 183 km; adults: 222 km), with children living significantly closer than adolescents (p = 0.03) and adults (p = 0.001). Overall, 44.8% of patients resided in large cities, with significant age-group differences (p < 0.001). Paediatric cases were concentrated in urban areas, whereas adults were more geographically dispersed. Among adults, distance varied by indication (p = 0.021), but not in younger groups. This pattern persisted despite the nationwide referral network.
LIMITATIONS, REASONS FOR CAUTION
The retrospective design precludes causal inference. Distances were calculated as straight-line measures instead of real travel time, and socioeconomic factors were not available. Furthermore, only patients who successfully underwent OTC were available for analysis. Consequently, the study cannot assess true access to fertility preservation, referral rates, counselling rates, or the number of eligible patients who did not proceed to treatment. Although patients were referred from centres across Germany, cryopreservation was centralized in Bonn. Regional referral relationships and the structure of the referral network may therefore have influenced the observed geographic distribution, particularly in paediatric patients, and may limit generalisability to the entire German population.
WIDER IMPLICATIONS OF THE FINDINGS
The findings demonstrate age-dependent geographic utilisation patterns among patients who underwent OTC. These patterns may reflect differences in referral pathways, counselling practices, and utilisation of fertility preservation services. However, because only patients who successfully underwent OTC were included, the study cannot directly assess referral rates, unmet need, or access barriers. Expanding structured referral pathways and reimbursement policies may improve equitable utilisation of fertility preservation services.
FUNDING
Intramural funding from the University Hospital Bonn.
DISCLOSURES
The authors declare no conflicts of interest.
TRIAL REGISTRATION NUMBER
N/A