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