Ovarian tissue cryopreservation in girls and adolescents at risk of gonadotoxicity: a 15-year experience in 159 patients from a referral program.

PURPOSE: To report a 15-year single-center experience of a pediatric fertility preservation program based on ovarian tissue cryopreservation (OTC), focusing on patient selection, program logistics, and endocrine and reproductive outcomes with explicit consideration of age- and treatment-related evaluability.

METHODS/PATIENTS: Retrospective observational study including all girls and adolescents who underwent OTC between 2010 and 2025. Eligibility was based on structured gonadotoxic risk assessment integrating diagnosis, alkylating-agent exposure, radiotherapy fields/doses, and hematopoietic stem cell transplantation (HSCT). Outcomes were analyzed descriptively. Ovarian function was assessed in patients considered evaluable at last follow-up (aged ≥ 13 years, off treatment, and with endocrine follow-up available).

RESULTS

A total of 159 patients underwent OTC (median age at OTC 11.0 years). Malignant diseases accounted for 131/159 (82.3%), including leukemias/lymphoblastic lymphomas 35/159 (22.0%) managed in the context of HSCT, and other malignancies 96/159 (60.4%); non-malignant conditions accounted for 28/159 (17.7%). OTC was coordinated with another procedure under anesthesia in 106/159 (66.6%), and ovarian transposition was performed in 27/159 (17.0%) when abdominal and/or pelvic radiotherapy represented the main gonadotoxic risk. Among patients evaluable for ovarian function (n = 83), primary ovarian insufficiency was diagnosed in 36/83 (43.4%) (36/159, 22.6% overall); hormone replacement therapy was administered in 31/36 (86.1%).

CONCLUSION

A structured, risk-based OTC program can be integrated into pediatric oncology care with close logistical coordination. Clear definition of evaluability denominators and long-term multidisciplinary follow-up are essential for accurate interpretation of endocrine outcomes in this high-risk population.