Fertility-Sparing Management in Ovarian Cancer: A Systematic Review

Fertility-sparing management (FSM) has emerged as an important consideration in young women with ovarian cancer, particularly as survival outcomes improve and preservation of reproductive potential becomes a key quality-of-life priority. However, the oncologic safety and reproductive efficacy of FSM remain incompletely defined. We conducted a systematic review in accordance with PRISMA 2020 guidelines (PROSPERO ID: CRD420261368106) to evaluate oncologic and reproductive outcomes following FSM in ovarian tumors. PubMed/MEDLINE, EMBASE, Scopus, and Cochrane CENTRAL were searched for studies published between January 1995 and September 2025. Eligible studies included women undergoing FSM with reported oncologic and/or reproductive outcomes. Of 464 records identified, 56 studies involving approximately 7000 participants across multiple countries met the inclusion criteria. Included populations encompassed borderline ovarian tumors (BOT), epithelial ovarian cancer (EOC), malignant ovarian germ cell tumors (MOGCT), and sex cord-stromal tumors (SCST), predominantly at early-stage disease. Recurrence rates ranged from 5% to 76% in BOT, 5% to 20% in early-stage EOC, and were generally below 10% in MOGCT and SCST. Five-year disease-free survival ranged from 80% to 95% in BOT and early-stage EOC and exceeded 85-95% in MOGCT and SCST, while overall survival exceeded 90% in BOT and 85-95% in early-stage EOC. Pregnancy rates ranged from 25% to 88%, with live birth rates between 20% and 80%. Most pregnancies occurred spontaneously, although assisted reproductive technologies improved reproductive success without increasing recurrence risk. Fertility-sparing management appears to be oncologically safe in carefully selected patients while preserving meaningful reproductive potential. Despite heterogeneity across studies, future research should focus on prospective designs with standardized outcome reporting and longer follow-up to optimize patient selection and management strategies.