Table 1.

Fertility-sparing interventions in women with cervical or endometrial cancer

Diagnosis	Type of Surgery	Description	Reproductive and Obstetric Outcomes	Oncologic Outcome	Quality of Life
Cervical Cancer FIGO Stage IA1 (microinvasion <3 mm)	Large loop excision of the transformation zone (LLETZ) or conization if absence of lymph vascular space invasion and negative margins are confirmed	Complete resection of the transformation zone	No fertility impairment reported. OR 1.7 for preterm delivery and 2.69 for premature rupture of membranes; associated with resection size. No difference in neonatal outcome [130]	Similar oncologic outcomes reported in comparison with hysterectomy [10]	Conization has not been associated with reduced quality of life or sexual satisfaction [49]
FIGO Stages IA2, IB1 < 2 cm	Cervical conization and laparoscopic lymphadenectomy	Conization of the cervix and laparoscopic pelvic lymphadenectomy	Spontaneous conceptions of about 47 %. Prematurity rates reported with 14.3 % of infants born <32 weeks of gestation [21]	Excellent rates of 5-year disease-free survival (97 %) [21]	Conization with laparoscopic lymphadenectomy has not been associated with reduced quality of life or sexual satisfaction [49]
FIGO Stages IA2, IB1	Radical trachelectomy. Techniques described for vaginal, abdominal, laparoscopic or robotic trachelectomy	Resection of the cervix and surrounding parametria with conservation of the uterus and the ovaries, pelvic lymphadenectomy	Spontaneous pregnancy rates in >60 % of patients Preterm deliveries with 28 % of infants born <32 weeks of gestation [17, 132]	Rates of recurrence and mortality are comparable with those described for similar cases treated with radical hysterectomy; long-term survival 98.4 %. Low relapse rates (4.5 %) [16, 17]	Lower quality of life than healthy controls but similar to radical hysterectomy No significant impairment in sexual satisfaction Long-term bladder complications (40 %) and lymphedema (10 %) [46–48]
FIGO Stage IB1, >2 cm	Neoadjuvant chemotherapy followed by radical trachelectomy	Three cycles of paclitaxel, cisplatin and ifosfamide followed by radical trachelectomy	After neoadjuvant chemotherapy and trachelectomy up to 86 % live-birth rates with 86 % spontaneous conception rate [134]	Reported relapse rate of 7.6 % with 90 % survival [23, 24]	Lack of data
Endometrial Cancer FIGO stage IA	Medical conservative treatment with hormone therapy using progestational agents either orally or by IUD for >6 months Myometrial evaluation by MRI should be performed to confirm absence of myometrial infiltration and no extrauterine involvement [52].	Follow-up by hysteroscopic exams with endometrial biopsies every 3 months	Pregnancy rates of >60 % Uneventful pregnancies reported [63, 72]	Positive response rate to progesterone treatment of 72 %. Either oral or local IUD treatments proposed, as well as a combination of both. Relapse rate of 50 %. A second round of progesterone therapy in cases of relapse has been associated with a response rate of up 89 % [55, 57, 60, 62]. A levonorgestrel IUD has shown greater regression on histology, lower relapse rates and lower rates of hysterectomy for treatment of complex endometrial hyperplasia vs. oral progesterone [57–59].	Levonorgestrel IUD treatment has been associated with fewer systemic side effects compared with oral progesterone administration [79, 80]

Modified from: Rodriguez-Wallberg KA, Oktay K. Fertility preservation during cancer treatment: clinical guidelines. Cancer management and research. 2014;6:105-17

Abbreviations: FIGO International Federation of Gynecology and Obstetrics, LLETZ large loop excision of the transformation zone; IUD intrauterine device, OR odds ratio