The Italian Medically Assisted Reproduction Registry (ItMARR) was established by a Decree of the Minister of Health issued on October 7^th, 2005. ItMARR has a crucial role in clearly and publicly disseminating epidemiological information on MAR activities and outcomes. ItMARR data are collected in aggregate form and their submission is mandatory as stipulated by Law 40/2004. The aim of this article is to make a comprehensive overview of the activity of authorized centers that perform IUI and ART in Italy. Data used in this article refer to MAR treatments started between January 1^st and December 31^st, 2021. MAR techniques were performed by 340 centers. In total, 92,407 ART cycles and 15,660 IUI cycles were performed in 2021. Gametes donation cycles represent 14.6% of ART activity and 4.2% of IUI. ART cycles performed per million women of childbearing age were 9077. In 2021, 3.8% of births in the general population in Italy were a result of ART application. In 2021, MAR activity had a strong increase compared to the previous year in which there were strong limitations on reproductive treatments due to the COVID-19 pandemic. Pregnancy rates per transfers were 29.4% with fresh techniques, 35.2% with FER, 26.3% with FO, 41.2% with OD and 37.9% with SD. The decreasing trend of multiple deliveries continues. The ItMARR has become a great asset in the reproductive health scenario promoting a better MAR information dissemination. ItMARR is working on the implementation towards a "cycle-by-cycle" data collection system. This will bring the Italian monitoring system in line with others European countries.

Background: Preserving fertility in young women with cancer is crucial for comprehensive care. Based on GBD 2023 estimates, approximately 1000 women aged 15–39 are diagnosed with haematological malignancies annually in Italy. Guidelines recommend timely fertility preservation (FP) counselling for all at-risk patients, yet real-world access data remain limited. Methods: This multicentre, retrospective observational study analysed FP counselling for women aged 15–39 with haematological malignancies from 2015 to 2023. Counselling data were extracted from the Italian Assisted Reproductive Technology Registry (IARTR). This data collection system, known as PreFerIta, was developed within a project supported by the Italian Ministry of Health to collect data on Fertility Preservation (FP) treatments in oncology patients and/or those at risk of iatrogenic infertility, provided in seven specialised ART centres across Italy. The PreFerIta database includes data on both oocyte cryopreservation and ovarian tissue cryopreservation. Annual visits were related to the estimated regional incidence of new haematological malignancies (GBD 2023). Counselling-to-incidence ratios, absolute/relative gaps, and 95% confidence intervals (CIs) were calculated. Results: From 2015 to 2023, an estimated 4473 new haematological malignancies occurred in the catchment regions. Concurrently, 1200 FP counselling visits were recorded. While incidence modestly declined, counselling activity remained high. The counselling-to-incidence ratio increased from 17.33% in 2015 to 31.92% in 2018, stabilising between 26% and 31% thereafter (30.98% in 2023). The relative counselling gap decreased from 82.67% to 69.02%. These ratios represent lower-bound estimates of access to specialised oncofertility consultations. Conclusions: In this Italian network, approximately one in four to one in three incident haematological malignancies in young women were associated with specialised FP counselling. This reflects a substantial integration of oncofertility services into haematology care, highlighting opportunities to further strengthen referral pathways and achieve full guideline concordance.