Access to pediatric ovarian and testicular tissue cryopreservation in the USA: a national survey of clinical delivery models and research practices

Purpose To characterize structural access to pediatric ovarian and testicular tissue cryopreservation in the USA, including service availability, delivery models, and institutional research practices. Methods We conducted a national cross-sectional survey of institutions identified from the FDA Human Cell and Tissue Establishment Registration database and the Oncofertility Consortium “Clinic Finder.” Institutions completed an online survey of multiple-choice and free-text items characterizing clinical delivery, case volume, and research practices. Descriptive analyses and geospatial mapping were performed. Results Among 345 contact-eligible institutions, 36 responded (10.4%); this denominator was intentionally broad and substantially exceeded the number of institutions expected to provide these services. Twenty-three institutions reported offering ovarian tissue cryopreservation (OTC) and 23 reported offering testicular tissue cryopreservation (TTC); 21 provided pediatric OTC and 19 institutions provided pediatric TTC. Most functioned in a single role, commonly as surgical procurement sites rather than cryopreservation centers. Median annual case volume was 12.5 cases for OTC (interquartile range [IQR], 3.5–23.0) and 10.0 cases for TTC (IQR, 5.0–19.0). Pediatric patients accounted for a median of 100.0% of cases for both OTC and TTC, with prepubertal patients representing a substantial proportion, particularly for TTC. Research oversight and specimen utilization varied, with frequent external laboratory collaboration. Conclusion Pediatric ovarian and testicular tissue cryopreservation in the USA functions through an informal, institutionally coordinated hub-and-spoke model of distributed surgical procurement and centralized cryopreservation. Variability in service roles, research oversight, and specimen utilization highlights opportunities to improve transparency, coordination, and access.