Methods | Indication | Advantages | Risks and Limitations |
Cervical conization | -Stage IA cervical cancer without vascular invasion or lymph node metastasis | -Fertility is preserved | -Preterm delivery or abortion still remain |
Radical trachelectomy | -Stage IA1 with vascular invasion and cases of stages IA2 to IB1 | -Fertility is preserved | -Possibilities of conversion to radical hysterectomy -Preterm delivery or abortion still remain -Artificial reproductive technology is needed in some cases |
Ovarian protection against radiotherapy | -Mainly advanced cervical cancer of stage III or higher | -Radiation exposure to the ovaries may be prevented | -Sometimes oocyte retrieval is difficult for the cases of ovaries movement |
Medroxyproge-sterone acetate (MPA) therapy | -Grade 1 endometrioid adenocarcinoma without muscle invasion or ectopic metastasis | -Feasibility of treatment -Good tolerability -11% - 56% of response rate | -Frequent follow-up is necessary while treatment -Side effect (liver toxicity, hypercoagulopathy, etc.) -Possibilities of recurrence -Fertility is not preserved when cancer has progressed |
Unilateral salpingo-oophorectomy of the affected side + omentectomy, peritoneal sampling | -Stage IA epithelial ovarian cancer with histology of non-clear cell and grade 1/2 -All stages of borderline tumor -All stages of malignant ovarian germ cell tumor | -Preservation of the uterus and contralateral ovary with fertility maintenance -Usually good prognosis | -Risk of progression in case of inadequate staging -High rate of malignant transformation at relapse in patients aged ≥40 years for borderline tumor -Chemotherapy (BEP) remains a contentious issue over concerns about fertility and late side effect of treatment |
Gonadotropin-releasing hormone (GnRH) analog | -Various kinds of tumors -It is concomitantly administered while undergoing radiotherapy or chemotherapy | -Preventive effect on ovarian toxicity caused by chemotherapy or radiotherapy | -Evidence of the efficacy is limited and is still controversial |
Freezing of unfertilized oocytes | -Various kinds of tumors -Procedure is performed before cancer treatment | -Applicable for all women with menstruation | -Takes at least several weeks after menstruation for oocyte retrieval -Ovarian stimulation is necessary -Compromise the need for immediate chemotherapy for the primary disease -Low pregnancy rate |
Freezing of embryo | -Various kinds of tumors -Procedure is performed before cancer treatment | -Established technique as general infertility treatment -High pregnancy rate than freezing of unfertilized oocytes | -Takes at least several weeks after menstruation for oocyte retrieval -Ovarian stimulation is necessary -Compromise the need for immediate chemotherapy for the primary disease -Applicable only for married couple |
Freezing of ovarian tissue | -Various kinds of tumor including pediatric cancers, such as leukemia, lymphoma -Procedure is performed before cancer treatment | -Applicable even for women before menarche -Ovarian stimulation is unnecessary -Many oocytes can be preserved at once -Immediate treatment for the primary disease is possible | -Risk of reintroducing malignant cells when cryopreserved ovarian tissue is autotransplanted after cancer treatment -Still investigational level |