Fertility-Preserving Treatments in Patients with Gynecological Cancers: Chinese Experience and Literature Review

  • Liu, Chun-Yan (Obstetrics and Gynecology Department, China-Japan Friendship Hospital) ;
  • Li, Hua-Jun (Obstetrics and Gynecology Department, China-Japan Friendship Hospital) ;
  • Lin, Hua (Obstetrics and Gynecology Department, China-Japan Friendship Hospital) ;
  • Ling, Bin (Obstetrics and Gynecology Department, China-Japan Friendship Hospital)
  • Published : 2015.07.13


We conducted a retrospectively reviewed of the literature published of patients underwent fertility-preserving treatments for cervical, endometrial and ovarian cancers using the WANFANG database in Chinese. A majority were retrospective studies and case reports. With cervical cancer, radical trachelectomy(RT) in combination with pelvic lymphadenectomy could preserve the fertility of patients with early stage IA1-IB1 cancers, Tumor size ${\leq}2cm$ should be emphasized as the indication of RT in considering of the higher recurrent rate in patients with tumor size >2cm. For endometrial cancers, there is much experience on it. Given accurate pretreatment assessment, hormonal therapy is feasible management option to preserve fertility in young patients with early stage lesions that limited to the endometrium and well differentiated. High dose progestin have been applied, oral medroxyprogesterone acetate (MPA), 250-500mg/day, megestrol acetate 160-480mg/day. Other therapies that have been used in a limited number of cases include GnRH analog, intrauterine devices (IUDS) containing progestogen, usually combination of these therapies. All patients should be followed up by ultrasound and/or MRI evaluation, and endometrial curettage at intervals of 3 months. With ovarian cancer, in China, fertilitypreserving surgery in patients with stage IA (grade G1) of epithelial ovarian tumor and patients with germ cell tumor and borderline ovarian tumor have been successfully performed.


Gynecological cancers;fertility preserving;treatment;recurrence;outcome


  1. Anchezar JP, Sardi J, Soderini A (2009). long-term follow-up results of fertility sparing surgery in patients with epithelial ovarian cancer. J Surg Oncol, 100, 55-8.
  2. Baalbergen A, Smedts F, Helmerhorst TJ (2011). Conservative therapy in microinvasive adenocarsinoma of the uterine cervix is justified: an analysis of 59 cases and a review of the literature. Int J Gynecol Cancer, 21, 1640-45.
  3. Cade TJ, Quinn MA, McNally OM, et al (2010). Predictive value of magnetic resonance imaging in assessing myometrial invasion in endometrial cancer: is radiological staging sufficient for planning conservative treatment? Int Gynecol Cancer, 20, 1166-69.
  4. Cao DY, Yang JX, Wu XH, et al (2013). comparisons of vaginal and abdominal radical tracheletomy for early-stage cervical cancer: preliminary results of a multi-center research in China. Br J Cancer, 109, 2778-82.
  5. Cao Y, Xing Q, Zhang ZG, et al (2009). Cryopreservation of immature and in-vitro matured human oocytes by vitrification. Reprod Biomed Online, 19, 369-73.
  6. Chen Yi-le, Li Le-sai, Tang Zhen-zi, et al (2013). Analysis of the security, pregnancy outcomes, and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy. Chin J Obstet Gynecol, 48, 352-57.
  7. Chiva L, Lapuente F, Gonzalez-Cortijo L, et al (2008). Sparing fertility in young patients with endometrial cancer. Gynecol Oncol, 111, 101-104.
  8. Cobo A, Diaz C (2011). Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril, 96, 277-85.
  9. Dargent D, Brun JL, Roy M, et al (1994). Pregnancies following radical trachelectomy for invasive cervical cancer. Gynecol Oncol, 52, 105.
  10. Dargent D, Martin X, Sacchetoni A, et al (2000). Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer, 88, 1877-82.<1877::AID-CNCR17>3.0.CO;2-W
  11. Dursun P, Erkanli S, guzel AB, et al (2012). A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer. Int J Gynaecol Obstet, 119, 270-73.
  12. Ghaemmaghami F, Karimi Zarchi M, Naseri A, et al (2010). Fertility sparing in young women with ovarian tumors. Clin Exp Obstet Gynecol, 37, 290-94.
  13. Gurgan T, Salman C, Demirol A (2008). Pregnancy and assisted reproduction techniques in men and women after cancer treatment. Placenta, 29, 152-59.
  14. Howlader N, Noone AM, Krapcho M, et al (2014). SEER cancer statistics review, 1975-2010. National Cancer Institute, HTTP://
  15. Jeong-Yeol Park, Hextan Yuen Sheung Ngan, Won Park, et al (2015). Asian society of gynecological oncology international workshop 2014. J Gynecol Onco, 26, 68-74.
  16. Li J, Li Z, Wang H, et al (2011). Radical abdominal tracheletomy for cervical malignancies: surgical, oncological and fertility outcomes in 62 patients. Gynecol Oncol, 121, 565-70.
  17. Liu Q, Ding X, Yang J, et al (2013). The significance of comprehensive staging surgery in malignant ovarian germ cell tumors. Gynecol Oncol, 131, 551-54.
  18. Mojgan Karimi Zarchi, Azamsadat Mousavi, Mitra Modares Gilani, et al (2011). Fertility sparing treatments in young patients with gynecological cancers: Iranian experience and literature review. Asian Pac J Cancer Prev, 12, 1887-92.
  19. Noyes N, Porcu E, Borini A (2009). Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. Reprod Biomed Online, 18, 769-76.
  20. Park JY, Kim DY, Suh DS, et al (2008). outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes. Gynecol Oncol, 110, 345-53.
  21. Plaxe SC, Braly PS, Freddo JL, et al (1993). Profiles women age 30-39 and age less than 30 with epithelial ovarian cancer. Obstet Gynecol, 81, 651-54.
  22. Rodriguez M, Nguyen HN, Averette HE, et al (1994). National survey of ovarian carcinoma XII. Epithelial ovarian malignancies in women less than or equal to 25 years of age. Cancer, 73, 1245-50.<1245::AID-CNCR2820730419>3.0.CO;2-5
  23. Schilder JM, Thompson AM, DePriest PD, et al (2002). outcome of reproductive age women with stage IA or IC invasive epithelial ovarian cancer treated with fertility-sparing therapy. Gynecol Oncol, 87, 1-7.
  24. Wang Li-ping, Qiao Juan, Li Hai-ye, et al (2014). The effect of fertility-preservation therapy for 16 cases with endometrial carcinoma. Chinese Clin Oncol, 19, 164-67.
  25. Wang Yan, Wang Yue, Li Yi, et al (2011). Investigation of the status and recurrence of young non-benign ovarian tumor patients after fertility preservation therapy. Chin J Clin Obstet Gynecol, 12, 425-27.
  26. Yang Fan, Wang Yue, Zhao Chao, et al (2013). Oncological safety and pregnancy after Cold-knife conization in early-stage cervical cancer. Chin J Clin Obstet Gynecol, 14, 8-10.
  27. Yao Yuan-yang, Wang Yue, Wang Jian-liu, et al (2013). A multi-center study on the outcomes of the oncology, fertility and pregnancy in patients after undergoing the fertility-sparing treatments with early-stage cervical cancer. Chin J Clin Obste Gynecol, 14, 4-7.
  28. Yu M, Yang JX, Wu M, et al (2009). Fertility-preserving treatment in young women with well-differentiated endometrial carcinoma and severe atypical hyperplasia of endometrium. Fertil Steril, 92, 2122-24.

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