Advances to fertility preservation in patients with gynecological cancers

Fertility preservation has become increasingly important in the multidisciplinary care of women with gynecologic cancers, especially as delayed childbearing has contributed to a rise in cancer diagnoses during reproductive ages. In this context, advancements in fertility preservation have greatly enhanced the variety of strategies offered to women facing gynecologic cancers, offering both established and emerging options to women diagnosed with cervical, endometrial, and ovarian malignancies.

This review provides a comprehensive overview of current fertility-preserving approaches in gynecologic oncology, highlighting latest developments in surgical, medical, and assisted reproductive techniques. A literature search was conducted in PubMed, Scopus, EMBASE, and Web-of-Science (2010-2025). We examine the indications, oncologic safety, and reproductive outcomes of fertility-sparing procedures, including radical trachelectomy, hormonal therapy for early-stage endometrial cancer, and conservative management of borderline ovarian tumors. Additionally, we discuss the role and timing of oocyte/embryo and ovarian tissue cryopreservation, particularly in urgent gynecologic oncological case scenarios. Critical challenges such as optimal patient selection, individualized risk assessment, and coordination between gynecologic oncology and fertility specialists are addressed.

Fertility preservation in gynecologic oncology has evolved considerably, yet several unmet needs remain, and future research with a focus on improving oncologic and reproductive outcomes is needed.