Development of medical freezing measures in women during the last decade from 2014 to 2023: registry data of the tri-national network FertiPROTEKT.

research questionTo what extent have fertility preservation interventions evolved between 2014 and 2023, and what factors have influenced changes in their utilization and prevalence?

designBased on the FertiPROTEKT registry, comprising 163 centres across Germany, Austria, and parts of Switzerland, the quantitative development of ovarian stimulation for oocyte cryopreservation and ovarian tissue cryopreservation was evaluated from 2014 to 2023. Analyses were stratified according to the kind of participating centre, patient age, and the spectrum of underlying diseases. In addition, data were statistically compared for the periods 2014/2015 (P1) and 2022/2023 (P2).

resultsApproximately 14,000 women received counselling across all three countries between 2014 and 2023. Among these, 3,996 females underwent ovarian stimulation for oocyte cryopreservation, and 3,478 underwent ovarian tissue cryopreservation. The number of oocyte cryopreservation cycles increased substantially from P1 to P2, whereas the number of ovarian tissue cryopreservation procedures remained relatively stable. The increase in oocyte cryopreservation was substantially greater in private centres (197% increase: 308 to 916 cycles) compared to public institutions (39% increase: 818 to 1,136 cycles; p < 0.001). The rise in oocyte cryopreservation cycles parallels an increase in breast cancer cases presenting for fertility preservation; this temporal coincidence suggests a potential association but does not establish causation. The predominance of breast cancer patients also influenced the age distribution of oocyte cryopreservation cases. Among oocyte cryopreservation procedures, absolute numbers increased across all age groups up to 40 years, with the largest absolute increase in women aged 31-40 years (212 to 732 cycles, 245% relative increase).The overall age distribution of procedures changed only slightly, although younger patients were more likely to undergo ovarian tissue cryopreservation. Additionally, new indications such as endometriosis and gender dysphoria have become increasingly relevant over the past 5 years.

conclusionThe number and distribution of fertility preservation procedures have changed notably during the last decade, driven primarily by shifts in the reimbursement strategies and the type of centres providing care. These developments should be carefully considered in the future design and implementation of fertility preservation programmes. However, decisions regarding specific fertility-preserving interventions must also be guided by scientific evidence.