Fertility preservation service for children and young adults at high risk of infertility; the hub and spoke model
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In brief
In brief
This study evaluates a decade-long evolution from centralized to networked fertility preservation services for at-risk children and young adults. The hub-and-spoke model expanded from 4 to 349 annual referrals, with 85% of procedures now performed at local spoke sites, successfully delivering ovarian and testicular tissue cryopreservation closer to patients' homes.
- Hub and Spoke model increased fertility preservation referrals from 4 to 349 patients/year over a decade, expanding access nationwide.
- Testicular cryopreservation grew from 0% to 49% of cases by 2023, addressing previously underserved male pediatric oncology patients.
- Decentralization shifted 85% of procedures to spoke sites by 2023, enabling treatment closer to home while maintaining safety standards.
- 81% of referred patients successfully underwent tissue procurement and storage, demonstrating high conversion from referral to preservation.
- Surgical challenges include theatre access variability, equipment standardization needs, and tissue handling technique consistency across sites.
Written by the GCMD Library team from the article.
Abstract
Purpose
To evaluate the evolution of fertility preservation surgery in children and young adults at high risk of infertility from a single centre to a networked ‘Hub and Spoke’ service.
Methods
A case note review of patients referred for ovarian or testicular cryopreservation between Jan 2013 and Dec 2023. Demographic data, procurement numbers, and site of procurement were collected. Specialist feedback was obtained to identify the challenges faced.
Results
Over time, the number of referrals increased from 4 to 349 patients per year with the number of Spoke centres rising to 36 ovarian and 16 testicular. In 2013–2014; 100% of procurement was ovarian as compared to 2023; 51% ovarian, 49% testicular. Of the 395 referrals in 2021, 81% (n = 319) went on to have procurement and storage of tissue. Between 2013 and 2016, 96% of cases were performed at the Hub. In 2023, 53/349 (15%) cases were performed at the Hub with the remaining 296 (85%) procured at Spoke sites. Surgical issues such as access to theatre, variation and availability of surgical equipment, thermal injury to ovarian tissue and variation in the size of the testicular specimen were identified.
Conclusion
The Hub and Spoke model successfully delivers treatment to patients close to home as safely possible within their local treatment centre.