Background Fertility preservation is recognised by WHO, UNICEF and the UN SDGs as a fundamental health right. Yet most oncofertility guidelines are not tailored to children, adolescents and young adults (CAYA) or to local system capacity, causing fragmented implementation, inequitable access and weak survivorship pathways. This paper describes new CAYA guidelines development and implementation strategies for Australia and New Zealand (ANZ) designed to close these gaps and build regional capacity. Methods In 2022, a bi-national consortium of clinicians, researchers, survivors and advocacy partners across paediatric and adult sectors initiated the first CAYA-specific oncofertility guideline in ANZ. Priorities were informed via multi-round Delphi panels including consumers. All 10 Australian paediatric oncology centres were invited to co-design oncofertility SOPs (Standard Operating Procedures) to support implementation. Data from focus groups were thematically analysed using the RE-AIM framework to assess acceptability, adoption, barriers and sustainability. Workforce development was embedded through 10 multidisciplinary working groups and 54 systematic reviews across surgical, clinical, psychosocial and health-system domains. Results Delphi achieved strong consensus (>85%) on framework, purpose and target populations. Risk of bias tools ensured methodological rigour, and external clinical, research and consumer review supported transparency and adoption. Reviews confirmed scarce paediatric/adolescent-specific evidence. Centre engagement produced SOPs in 9/10 paediatric oncology centres covering referral pathways, counselling timelines, governance and expertise, tailored to local readiness yet aligned with international frameworks. The process strengthened workforce capacity, fostered cross-sector collaboration, mentored early-career researchers and established a sustainable ANZ oncofertility network. Conclusion This initiative represents the first coordinated effort to translate global reproductive rights principles into a regional, equity-focused oncofertility guideline for CAYA. Integrating guidelines with centre-specific SOPs creates a practical advocacy platform, evidence-based standards plus real-world insights, for national adoption. Embedding consumer voices, local SOPs and early-career development is closing practice gaps and shaping the future workforce. The ANZCO model sets a benchmark for youth-centred survivorship care and offers a globally relevant framework for embedding reproductive rights in adolescent and young-adult cancer survivorship.

Background Non-growing follicles (NGF), constituting the ovarian reserve, are finite and established before birth. Ovarian tissue cryopreservation (OTC) often serves as a primary method of fertility preservation in child, adolescent and young adults (CAYA). Previous models had limited data on paediatrics and minimal methodological detail of follicle density (FD). This study aims to fill these gaps by developing a comprehensive model of FD in a CAYA cancer cohort without prior chemotherapy. Development of a centile chart could be of clinical value in predicting future fertility from cryopreserved ovarian tissue Methods The study recruited chemo-naïve patients aged 0-20 years who underwent OTC. A small proportion of tissue was fixed, processed, H&E-stained sections were scanned, and all follicles were counted and classified according to the NICHD proposed nomenclature. Follicle numbers within a cortical depth of 1 mm were used to determine FD for all follicular categories. NGF included primordial and transitional primordial follicles. Logarithmic linear regression models of FD according to age were described for each follicle category. JavaScript was used to create a web-based FD centile chart calculator. The project was approved under the Royal Children’s Hospital Human Research Ethics Committee project RCH HREC 2019.022. Results We recruited 134 patients, evenly distributed across the age range [0-5y: 28 (20.9%), 5.1-10y: 38 (28.4%), 10.1-15y: 40 (29.9%), 15.1-20y: 28 (20.9%)]. Mean NGF FD at birth was 35.51/mm2, halving every 6.3 years (p< 0.001). Growing follicles (primary to advanced follicles), have smaller FD at birth (0.9/mm2) p = 0.9 and have a longer half-life, >10 years (p< 0.001). An easy-to-use centile calculator web app has been developed. Conclusions Our study reports FD for a large population of CAYA chemo-naïve patients. We report half-life declines in FD across all types of follicles, with NGF showing the steepest decline. We introduce the first centile chart of follicle density, as well as a user-friendly web-based centile chart calculator, which will be helpful for clinicians.

Comprehensive sexuality education (CSE) equips youth with knowledge, life skills and attitudes to achieve healthy respectful relationships, and reach their optimal life and reproductive goals. This paper provides an overview of the current state of CSE globally, explores the challenges and facilitators to CSE implementation, and discusses the untapped agency of clinicians and professional medical societies in improving CSE delivery. Best practice CSE is implemented within school-based curricula taking a life-course approach (from childhood and beyond). CSE is enshrined within the right to education, health and well-being. The aspiration is for all youth to have access to CSE to reach their full potential. Great gains have been made, but there are significant economic, geographic and cultural barriers to implementation globally, leaving youth at risk for unwanted pregnancy, sexual violence, sexually transmitted infection, adversely impacting their future productivity and independence. Physicians have the potential to play a significant role in multiple domains of CSE including policy, advocacy and research. However, there is a need for physicians to develop policy skills and experience through dedicated medical education. Leveraging health providers beyond the clinic space can deliver significant population benefits for policy and practice and can help build capacity in the next generation of providers for delivering CSE-solutions for the future. Comprehensive sexuality education is a program for adolescents and youth that exists at the intersection of health and education. It provides young people with skills, knowledge, and attitudes to achieve healthy, respectful relationships and reach their optimal life and reproductive goals. This includes reducing the risk of unwanted pregnancy, exposure to sexual violence, and sexually transmitted infections. It also enables completion of schooling and improves the ability to find paid work, enhancing a young person’s prospects. CSE is embedded within the basic human right to education, health, and well-being. The goal is for all youth to have access to CSE to reach their full potential. However, there are many barriers to implementing CSE, such as lack of resources, training, and effective policies. Physicians are an untapped resource in CSE implementation. Pathways for physicians to enter key public-policy roles are not well-established and need further development. For physicians to have an impact to effect greater access and implementation of school-based CSE, they need to i) expand their medical training to better prepare them to address clinical problems, inform policy and train future generations; ii) encourage research consortiums worldwide to find CSE solutions for underrepresented communities; and iii) better advocate for CSE when facing policies that could negatively affect youth. Overcoming these barriers and leveraging health providers beyond the clinical space has the potential to deliver significant population benefits for policy and practice and can help build capacity in CSE.

Climate change is an escalating global crisis that disproportionately threatens the health and rights of children and adolescents, with girls facing particularly heightened vulnerability. Increasing temperatures, extreme weather events, food and water insecurity, and exposure to environmental toxins directly and indirectly affect sexual and reproductive health. These impacts include altered timing of menarche, worsened dysmenorrhea, increased risks of subfertility and pregnancy complications, and reduced access to essential reproductive health services. Broader climate-related instability further contributes to malnutrition, disruption of education, child marriage, displacement, and gender-based violence, compounding longstanding gender, socioeconomic, and geographic inequities. FIGIJ affirms climate change as a health emergency and aligns itself with international efforts calling for urgent, coordinated action. FIGIJ supports the development of strong coalitions between governments, health care systems, and communities to amplify the health care sector's voice in global and regional climate advocacy. Protecting the next generation requires coordinated efforts, effective collaboration, and an ongoing commitment to supporting a healthier, more resilient and equitable future.

Background Decision aids (DA) may help to reduce conflict around complex fertility decisions through provision of unbiased information and values clarification. Eye-tracking technology (ETT) can assist with the codesign of electronic DA by examining dwell time and fixation points of users to examine what areas gain most attention. This study used ETT to assess how childhood cancer survivors, parents, and healthcare providers navigated an electronic oncofertility DA and perceived its content and functionality. Methods A mixed-methods cross-sectional study engaged consumers (parents of paediatric cancer patients and young survivors) and healthcare providers. Specific Areas of Interest (AOIs) within the decision aid were pre-selected based on perceived importance of information to users for decision-making. Attention to these areas was measured using eye-tracking parameter (fixations and dwell-time). Usability of the DA was examined through thematic analysis of participant 'think-aloud' sessions while reviewing the DA, which provided insights into the system’s usability, functionality, and content. Results Seven consumers and 10 healthcare providers participated, navigating the AOIs in the same sequence. Most participants allocated more time exploring other sections of the DA rather than the designated AOIs . This included areas that covered fertility preservation fundamentals, how age and cancer affect fertility, and key considerations for preservation decisions. Participants highlighted the need for improvements in clarity, usability, and content while expressing positive views about the DA. Recommendations for gender neutral language and enhanced visual and interactive tools indicated a demand for a more user-friendly and inclusive DA. Conclusion The ETT evaluation highlighted that linguistic, usability, content and design enhancements were required for the DA. ETT is a useful tool for engaging survivors, parents, and healthcare providers in developing and refining decision support tools to better meet stakeholders' needs.

Background Correct preoperative diagnosis of ovarian masses can facilitate targeted minimally invasive treatment for benign disease, and improved prognosis for those with malignancy. To stratify risk of malignancy the O-RADS Lexicon, IOTA ADNEX 2 Step Strategy and IOTA simple rules can be used but have not been validated in paediatric and adolescent populations. The study objective is to evaluate the diagnostic performance of the IOTA Simple rules, O-RADS Lexicon, ADNEX 2 Step Strategy in a paediatric and adolescent population. Methods Retrospective external diagnostic validation study in a single tertiary referral centre for Paediatric Gynaecology in Australia, ethics approval number RCH HREC 38071. Experienced examiners retrospectively reviewed all images for children who had surgically removed masses between 1991 and 2019, and assigned classification based on the stratification systems. All images reviewed had been performed transabdominally. Results Total of 415 patients had ovarian surgery, median age 13 years (IQR 11-15 range 2-18). Histology or imaging was unavailable or imaging quality was inadequate to apply lexicons in 203. Of 212 masses reviewed 197 (92.9%) were benign (55 functional cysts (25.9%), 73 germ cell (34.4%), 28 epithelial (13.2%), 24 simple cysts (11.3%), 2 sex cord stromal tumours (0.9%), 15 non-classifiable (7.0%)). Malignant tumours comprised 2 borderline epithelial (0.9%) and 1 epithelial carcinoma (0.47%); 8 germ cell (3.8%) and 4 sex cord stromal tumours (1.9%).178 masses received an ORADS classification. The malignancy rates for ORADS 2, 3, 4, and 5 were 0%, 2.94%, 3.45% and 50% respectively. The area under the ROC curve (AUC) was 0.94 (95%CI 0.89 to 0.97). The optimal cut-off value for predicting ovarian malignancy was ORADS 4/5 with a sensitivity of 90.9%, specificity of 77.8%, and negative predictive value of 99.2%.163 masses were assessed using the Simple Rules, with histological malignancy rate of 0.77% (1/130) for benign; 62.5% (5/8) for malignant; and 24% (6/25) for those classified as inconclusive, with a AUC of 0.864 (95% CI 0.80-.91).175 masses were assessed using the IOTA 2 Step Strategy. Benign descriptors did not apply for 46% of benign masses (87/163) and 100% of malignant masses (12/12). Of those where the benign descriptors did not apply the chance of benign disease predicted by the ADNEX model was 83.8%. Conclusion The ORADS Lexicon was a superior diagnostic test compared to the simple rules and IOTA 2 step strategy on transabdominal imaging for predicting malignancy risk in a paediatric population

Background Fertility preservation (FP) in childhood and adolescent cancer patients offers potential for future biological parenthood, yet implementation in clinical practice is challenging. We report the development of a learning health system in paediatric oncofertility, which evaluated the performances of the programs during iterative changes in models of oncofertility care. Methods A bi-directional cohort study was undertaken in a tertiary paediatric centre pre- and post-implementation of a formalised FP program in August 2013, analysing data from 1987‒2023. Program performance was assessed across four time periods corresponding to three strategic redesigns of the oncofertility program by hospital management. The Network Maturity Grid evaluated six domains of the program‒leadership, governance, quality assurance, engagement, data and analytics, and research, rated on a 5‐point scale denoting increasing maturity. Process maturity was evaluated by health leaders from four different crafts‒oncofertility clinician-scientist, clinical and research program managers, and digital health expert. Results The findings demonstrated improvements in all six domains of the program from Time interval A (TIA) (1987 to July 2013; no formalised service, scores 0.9-1.3 across domains) to TIB (August 2013 to 2018; implementation of governance frameworks and registries, care in multidisciplinary teams; leadership score 3.0, governance 2.9, quality assurance 2.3, engagement 2.1, data/analytics 2.4, research 3.0). By TIC (2019–July 2021; coordinated care model with oncofertility coordinator and clinical lead), maturity was highest across domains, with leadership reaching 4.0, governance 3.7, quality assurance 3.7, engagement 3.2, data/analytics 3.2, and research 3.9. In TID (Jan 2022–July 2023; pivoted to monitoring and education role with distributed teams and no clinical lead), scores were maintained for research (4.0) and data/analytics (3.2) but declined across other domains: leadership fell to 2.6, governance to 3.3, quality assurance to 2.6, and engagement to 3.0. Conclusion FP programs embedded within tertiary paediatric settings may achieve equitable and safe standards with appropriate regulatory frameworks, an emphasis on family and clinician education, leadership and care coordination. Distributed care led by operational teams alone achieved less coverage compared to a dedicated oncofertility service with a clinical lead, and oncofertility coordinator embedded in an oncology service. Registries play a major role informing practice and should be an essential component of any oncofertility program.

Background Paediatric gynecology providers play leading roles in fertility preservation programs for prepubertal children, including male patients. While male adolescents may opt for sperm cryopreservation; procedural sperm retrieval may be possible for those who cannot collect a sample. This study aims to characterise predictive features of peripubertal and post pubertal males who had sperm successfully dissected from testicular tissue biopsies before gonadotoxic therapy. Methods At the Royal Children’s Hospital testicular tissue cryopreservation (TTCP) is approved under novel technologies governance. We performed a retrospective case review (2005–2023) of to describe age, Tanner stage, testicular volume, and diagnosis in peri/post-pubertal patients who had TTCP. Results Among 113 cases of TTCP in patients age 10-19 years: 31 (27.9%) had liquid cancer, 56 (49.6%) had solid cancer, and 24 (21.6%) non-cancer diagnoses. Of the 96 cases with sufficient records, 31 (32.2%) of patients had sperm dissected from testicular tissue. Of 58 cases with no prior gonadotoxic therapy for which we have complete records, sperm was found in 22 cases (37.9%) including in none who were genital Tanner stage 1, 33.3% who were genital Tanner stage 2, and 66.7%, 50.0%, and 87.5% of those who were Tanner stages 3,4 and 5, respectively. Additionally, sperm was dissected from 5.5% of males with testicular volume < 10 ml and 90.9% of those with testicular volumes >10mL (29 total). Sperm was dissected in 9.1%, 40.0%, 83.3%, and 50.0% of males aged 10-12, 12-14, 14-16, and 16 years and above, respectively. Conclusion While TTCP is experimental, testicular tissue dissection may offer a real chance of fertility restoration for peri and post pubertal patients who cannot provide sperm samples naturally. The best candidates are those who are Tanner stage 3 and above with testicular volume 10mL and above.

Background It is common practice for clinicians to use centile charts to evaluate paediatric patients with regards to head circumference, length, weight, height or BMI. Centile charts for achievement of pubertal development stages, such as achievement at a given age of Tanner stages, testicular volume, or menarche, however, are not commonly used. Knowledge of a patient’s centiles across various measures may help guide clinical practice and inform fertility related decisions, such as deciding on fertility preservation options for cancer patients. Clinicians will, moreover, be more likely to use centiles in practice if a centile calculator is easily accessible, such as in the form of a web app. Methods Published reference values were used for the probability of achieving Tanner stages (female breast and pubic, male genital and pubic) and menarche by a given age from van Buuren 2014 (doi:10.1177/0962280212473300) valid between 8-21 years, as well as testicular volume via orchiometer or ultrasound by age from Joustra et al 2015 (doi:10.1111/apa.12972) valid between 0.6-19 years. The web app was written in JavaScript using the Akima interpolation method to ensure agreement with reference values and minimise oscillations. To ensure accuracy, we conducted rigorous code reviews and validation testing. Interviews with clinicians were used to improve usability of the web app. Results The code review and validation testing indicated the app was accurate and reliable. We incorporated insights gathered from clinicians to refine the design and functionality of the app. The resulting calculator is now easily accessible online, providing clinicians with a reliable tool for assessing pubertal development in their patients. Conclusion This novel web app fills a gap in clinician tools, providing clinicians with a user-friendly tool to calculate and interpret pubertal stage centiles for paediatric, adolescent, and young adult patients. By offering easy access to these centiles, the app has the potential to enhance clinical decision-making, particularly in areas such as fertility preservation for cancer patients. Next steps include exploring its implementation and validation in diverse clinical settings.

The first national human papillomavirus (HPV)-based cervical screening programs began in 2017. Since then, a growing list of countries have moved, or want to move, to HPV-based screening. A benefit of HPV-based screening is that a sample does not need to be collected from the cervix by a health care practitioner. Self-collection has been demonstrated to give equivalent accuracy as practitioner-collected specimens when PCR-based clinically validated HPV assays are used. However, there are few clinically validated, PCR-based, HPV assays with on-label claims for self-collection. The current study, Self-Collection or Practitioner-Collection Evaluation 2 (SCoPE2), undertook a Validation of Human Papillomavirus Assays and Collection Devices for Self-Samples and Urine Samples (VALHUDES) protocol evaluation with individuals recruited in a colposcopy population in the context of an HPV-based screening program. SCoPE2 recruited 400 participants who took self-collected vaginal samples using a FLOQSwab. Practitioner-collected cervical samples were collected at colposcopy. HPV testing was performed using both the cobas 4800 and cobas HPV tests. The self-collected specimens demonstrated equivalent and noninferior relative sensitivity for histologically confirmed cervical intraepithelial neoplasia grade ≥2 (CIN2+) (n = 58) when compared with the practitioner-collected specimen for cobas 4800 (0.982) and cobas (1.037), but relative specificity was inferior. Additional analyses were undertaken to resolve referral, self-collected, and practitioner-collected discordant results. SCoPE2 demonstrates that self-collection is noninferior for detection of CIN2+ compared with a practitioner-collected specimen.

The International Federation of Pediatric and Adolescent Gynecology (FIGIJ) recognizes the severe impact of conflict, humanitarian crises, and war on the health and safety of women and girls. These settings exacerbate the risk of gender-based violence (GBV), including sexual violence, exploitation, and abuse, with long-lasting consequences on survivors' physical and mental well-being. Adolescent girls are particularly vulnerable, facing heightened risks of forced marriage, trafficking, and disrupted access to education and healthcare. FIGIJ calls for urgent, coordinated global action to prevent and respond to GBV in these contexts. This advocacy statement outlines key recommendations, including strengthening legal frameworks, enhancing healthcare and psychosocial support, improving inter-agency coordination, and prioritizing data collection and research. Through these measures, FIGIJ aims to empower women and girls, protect their rights, and promote sustainable, survivor-centered solutions to mitigate the impact of violence in conflict and humanitarian settings.

Treatment-induced ovarian function loss is a significant concern for many young patients with breast cancer. Accurately predicting this risk is crucial for counselling young patients and informing their fertility-related decision-making. However, current risk prediction models for treatment-related ovarian function loss have limitations. To provide a broader representation of patient cohorts and improve feature selection, we combined retrospective data from six datasets within the FoRECAsT (Infertility after Cancer Predictor) databank, including 2679 pre-menopausal women diagnosed with breast cancer. This combined dataset presented notable missingness, prompting us to employ cross imputation using the k-nearest neighbours (KNN) machine learning (ML) algorithm. Employing Lasso regression, we developed an ML model to forecast the risk of treatment-related amenorrhea as a surrogate marker of ovarian function loss at 12 months after starting chemotherapy. Our model identified 20 variables significantly associated with risk of developing amenorrhea. Internal validation resulted in an area under the receiver operating characteristic curve (AUC) of 0.820 (95% CI: 0.817-0.823), while external validation with another dataset demonstrated an AUC of 0.743 (95% CI: 0.666-0.818). A cutoff of 0.20 was chosen to achieve higher sensitivity in validation, as false negatives-patients incorrectly classified as likely to regain menses-could miss timely opportunities for fertility preservation if desired. At this threshold, internal validation yielded sensitivity and precision rates of 91.3% and 61.7%, respectively, while external validation showed 92.9% and 60.0%. Leveraging ML methodologies, we not only devised a model for personalised risk prediction of amenorrhea, demonstrating substantial enhancements over existing models but also showcased a robust framework for maximally harnessing available data sources.

Background Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women's and girls' daily lives and exacerbates gender inequality. We sought to estimate the prevalence of and factors contributing to menstrual-related absenteeism across low-income and middle- income countries. Methods We analysed cross-sectional data from 47 nationally or subnationally representative Multiple Indicator Cluster Surveys from 2017 to 2023, which comprised 3 193 042 individuals from 555 869 households across 44 countries; those with available information on the outcome of interest were included in our analysis. The outcome of interest was menstrual-related absenteeism from work, school, or social activities during the respondent's last menstrual period. Independent factors included age, household wealth index, use (vs no use) of menstrual materials (eg, pads, tampons, or cloth), availability of a private place to wash at home during menstruation, and contraceptive use (hormonal and other). Univariable and multivariable associations between each factor and menstrual-related absenteeism were analysed using log-binomial models. Prevalence ratios, estimated from the log-binomial models, represent the relative prevalence of menstrual-related absenteeism across different levels of the independent variables. Prevalences and associations were pooled by geographical region and overall across all surveys using a random- effects meta-analysis. Heterogeneity was assessed using the I2 statistic, and prediction intervals generated to reflect the variation in associations. Findings We included 673 380 women and girls aged 15-49 years in this analysis. The overall pooled prevalence of menstrual-related absenteeism was 150% (95% CI 127-173), with prevalence being highest in south Asia (197% [116-278]) and west and central Africa (185% [135-235]). After pooling data across surveys, girls aged 15-19 years were found to have a higher prevalence of menstrual-related absenteeism than those in older age groups, with overall pooled prevalence ratios ranging from 075 (068-082) in those aged 35-39 years to 092 (087-097) in those aged 20-24 years relative to the 15-19 years age group, with adjustment for area type (urban or rural). There was no association between menstrual-related absenteeism and household wealth or the use of menstrual materials. By contrast, having a private place to wash at home was associated with an increased prevalence of menstrual-related absenteeism (overall pooled prevalence ratio 125 [105-148], adjusted for wealth and area type). Menstrual-related absenteeism was less prevalent in women and girls using any contraceptives compared with those not using contraceptives (092 [087-096]), and for those using hormonal contraceptives compared with those using non- hormonal or no contraceptives (091 [084-099]), after adjusting for age, wealth, education level, parity, and area type. Interpretation Menstrual-related absenteeism is prevalent, especially in Asia and Africa and among adolescent girls. The age-independent protective effect of hormonal contraceptive use suggests that symptoms such as heavy menstrual bleeding or pain contribute to absenteeism. Future studies are urgently needed to better characterise these findings to inform relevant public health interventions.

Female genital mutilation/cutting (FGM/C) is a global problem affecting millions of girls and women. It involves cutting or removing parts of the external genitalia for no medical reason, often without consent, and has no health benefits. It is deeply rooted in tradition and often undertaken by lay practitioners. It is known to have immediate risks (of hemorrhage, infection, death) and long-term sexual, gynecological, obstetric, urological, and mental health sequelae including post-traumatic stress disorder. Health professionals worldwide need to be aware that girls and women from high-prevalence regions, including migrants, might have been subjected to FGM/C. FIGIJ and NASPAG strongly oppose the harmful practice of FGM/C as it is a form of gender-based violence and child abuse. FIGIJ and NASPAG call upon governments to ban the practice, and health professionals to develop culturally sensitive patient-centered clinical practice guidelines, and to respectfully cooperate with community leaders in order to co-design solutions that will eliminate the practice.

BACKGROUND:Remarkable progress in paediatric and adolescent fertility preservation (FP) has led to growing demand for services. However, best practice for gamete and gonadal tissue in paediatric and adolescent patients remains ill-defined. We explored the views of FP clinicians and laboratory staff on training needs for paediatric and adolescent FP procedures and services, the barriers across the FP pathway, and suggestions for improving service delivery. METHODS:Semi-structured interviews were conducted with multidisciplinary oncofertility experts from Australia and New Zealand. Data analysis of interview transcripts used the Framework Method. Results are reported with straight descriptions consistent with Qualitative Descriptive methods. RESULTS:Eighteen oncofertility clinicians and reproductive laboratory staff were interviewed. Paediatric surgeons viewed ovarian and testicular tissue harvesting within their scope of practice, though not gonadal tissue grafting. Education through direct observation and videos, and incorporation of oncofertility care into formalised surgical training programs was deemed important. Reproductive laboratory staff recommended that surgical training should include gonadal tissue harvesting techniques and guidance regarding adequate tissue volume removal. Reproductive laboratory staff requested bereavement training to better prepare them to support discussions with families. Oncofertility counselling and follow-up was not considered within scope of surgical practice by some surgeons and highlighted an unmet educational need by others. CONCLUSIONS:As FP procedures become more widespread, building of a surgical and laboratory workforce with the skills to implement care is important. A multidisciplinary approach, supported by clear governance frameworks outlining roles, responsibilities and best practice before, during, and after FP procedures, is essential to delivering high-quality, coordinated care.