Fertility-Sparing Management in Ovarian Cancer: A Systematic Review

Area of Science:

• Gynecology
• Oncology
• Reproductive Medicine

Background:

• Fertility-sparing management (FSM) is crucial for young women with ovarian cancer, balancing oncologic safety with reproductive desires.
• The oncologic safety and reproductive efficacy of FSM require further definition.

Purpose of the Study:

• To systematically evaluate oncologic and reproductive outcomes following FSM in various ovarian tumors.
• To assess the safety and efficacy of fertility-sparing approaches in women desiring future fertility.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines.
• Searched PubMed/MEDLINE, EMBASE, Scopus, and Cochrane CENTRAL (Jan 1995-Sep 2025).
• Included 56 studies (approx. 7000 participants) on borderline ovarian tumors, epithelial ovarian cancer, germ cell tumors, and sex cord-stromal tumors.

Main Results:

• Recurrence rates varied: 5-76% (BOT), 5-20% (early EOC), <10% (MOGCT, SCST).
• 5-year disease-free survival: 80-95% (BOT, early EOC), >85-95% (MOGCT, SCST).
• Pregnancy rates: 25-88%; live birth rates: 20-80%. Assisted reproductive technologies improved success without increasing recurrence.

Conclusions:

• Fertility-sparing management is oncologically safe for carefully selected patients with ovarian tumors.
• FSM effectively preserves reproductive potential, with successful pregnancies achievable.
• Future research should focus on prospective studies with standardized reporting for optimized patient selection and management.