Fertility-Sparing Treatments in Patients With Gynecologic Cancers

Fertility preservation is a critical consideration in the care of reproductive-aged patients with gynecologic cancers, yet referral to reproductive specialists remains low, indicating a gap between guidance and practice. We compared 28 clinical guidelines that addressed fertility-sparing management of endometrial, cervical, and ovarian cancers, and reviewed diagnostic workup, eligibility thresholds, surgical approaches, and surveillance protocols. Recommendations were synthesized into stage-specific pathways to delineate areas of consensus, highlight discrepancies, and map evidence gaps. There is broad agreement across multiple independent guidelines to support fertility-sparing treatment for carefully selected patients with: grade 1, stage IA endometrioid endometrial carcinoma; stage IA1-IB1 cervical tumors measuring less than 2 cm without high-risk features; and borderline ovarian tumors and most malignant germ cell tumors. Recommendations for higher stage disease and uncommon histologies, however, diverge and remain inconsistent. Overall guideline quality was moderate to high but frequently relied on limited evidence or expert opinion outside early-stage, low-risk conditions. Synthesizing current guidance clarifies areas where practice can be standardized and prospective data are needed. Embedding routine fertility counseling and referral into standardized pathways is an important step to improve uptake while maintaining oncologic safety and preserving fertility potential.