Fertility preservation in women with sarcoma: A real-world experience

Sarcomas frequently affect adolescent girls and young women, for whom future fertility is a critical concern. The urgency of initiating treatment-due to rapid tumor progression and the need for extensive diagnostic evaluation-often limits the window for fertility preservation prior to chemotherapy. However, emerging evidence indicates that gonadotoxicity is variable, and ovarian function may be preserved in a substantial number of cases. This observational cohort study evaluates the feasibility, timing, and clinical relevance of fertility preservation in young women treated for high-grade sarcomas or desmoid tumors at Cochin Hospital, AP-HP (Paris, France), with a focus on long-term ovarian function and reproductive outcomes. Among 59 patients (median age at first oncology consultation, 24.3 years), 13 underwent oocyte or ovarian tissue cryopreservation before or early during treatment. Therapy regimens included alkylating and non-alkylating chemotherapies, radiotherapy, or combinations thereof. At last follow-up, 49 women were alive, and 27 had experienced relapse or progression. Among 26 patients assessed for post-treatment ovarian function (median follow-up 62 months), 77% resumed menstruation, 27% conceived naturally, 78% of those actively attempting pregnancy were naturally successful, and 19% gave birth. No patient used cryopreserved oocytes or ovarian tissue. One patient underwent fertility preservation after therapy. These results suggest that systematic fertility preservation may not be mandatory for all patients and that spontaneous ovarian function recovery is common. The observed pregnancy outcomes underscore the importance of personalized, patient-centered fertility counseling based on tumor characteristics and treatment modalities.