Characterizing patients who underwent ovarian tissue cryopreservation at a large academic center in the United States.

Objective: To describe characteristics and outcomes of ovarian tissue cryopreservation (OTC) patients over nearly 2 decades of institutional experience. Design: Retrospective observational study. Subjects: All patients who underwent OTC for any indication from January 1, 2008 to November 1, 2024. Exposure: Ovarian tissue cryopreservation at a combined academic fertility program at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania. Main Outcome Measures: Fertility outcomes were assessed, including oocyte and embryo vitrification, autologous ovarian tissue transplantation (OTT), pregnancies, and live births. Additionally, gonadotoxic treatment exposure and association with post-OTC outcomes, such as the development of premature ovarian insufficiency, hormone replacement initiation, and overall survival, were evaluated. Results: Of 216 patients who underwent OTC, 39 had procedures at Hospital of the University of Pennsylvania (median age, 24.4 ± 7.8 years), and 177 underwent procedures at the Children's Hospital of Philadelphia (10.3 ± 5.9 years). Malignancy was the indication for 77.8% of OTC procedures, whereas 22.2% of procedures had benign indications. Ovarian tissue cryopreservation procedures (biopsy, 92.1%; oophorectomy, 7.9%) were performed laparoscopically in most patients, with a small minority of procedures performed abdominally as part of a concurrent open procedure for clinical care. Concomitant oophoropexy was performed in 16 patients (7.4%) at the time of OTC. Additional fertility procedures included oocyte vitrification (n = 35, 25.7% via stimulation and 74.3% from the ovarian tissue) and embryo vitrification (n = 1, 0.5%). One patient underwent OTT but ultimately needed donor oocytes to have a live birth. Five patients had unassisted pregnancies with live births, and 2 patients had a live birth after an intrauterine insemination. Of the 208 patients (96.7%) who received chemotherapy after OTC, 198 (95.2%) were exposed to alkylating agents. Of 115 patients with follow-up data, 68.8% were diagnosed with premature ovarian insufficiency, and 63.6% initiated hormone replacement. At time of analysis, 29 patients (13.4%) were deceased. Conclusion: Ovarian tissue cryopreservation minimizes treatment delay and offers autologous fertility preservation. Although mortality rates in our cohort are relatively high, OTC provides the opportunity to preserve fertility, and some conceive without assistance. At our institution, only one patient has returned to undergo OTT. Additional studies are needed to understand patient factors that may contribute to tissue utilization to improve counseling and increase transplantation rates.