Fertility-sparing therapy ray of hope for cancer patients

Fertility-preserving treatment is a ray of hope for patients suffering from gynaecological cancer. Manav Mander talks to Dr Anandita about fertility-preserving treatments in patients with gynaecological cancers and how they offer hope to women wishing to conceive after recovery. She explains the available options, ideal candidates and long-term care involved in these approaches.

What is fertility-sparing treatment?

Fertility-sparing treatment refers to medical or surgical approaches that aim to treat early-stage gynaecologic cancers, while preserving a woman’s ability to conceive in the future. Traditional cancer treatments often involve removing the uterus, ovaries or fallopian tubes, which eliminates the possibility of pregnancy. However, for women diagnosed at an early stage and who wish to retain fertility, conservative options can offer hope without compromising cancer treatment.

What are treatment options available?

Fertility-sparing treatments include both surgical and non-surgical methods, depending on the type and stage of cancer. In cases like early-stage endometrial cancer, high-dose hormonal therapy—such as oral or intrauterine progesterone—can be used to suppress the disease. This is typically followed by regular biopsies to monitor regression. Surgical options vary by cancer type. For cervical cancer, procedures like cold knife conisation or radical trachelectomy (removal of the cervix while preserving the uterus) are considered. In early-stage ovarian cancer, a unilateral salpingo-oophorectomy (removal of one ovary and fallopian tube) may be performed, preserving the other ovary and uterus. In patients undergoing pelvic radiation, ovarian transposition (moving the ovaries out of the radiation field) can help maintain ovarian function. Additionally, cryopreservation techniques—such as freezing eggs, embryos or ovarian tissue—are increasingly used before treatment begins, offering future reproductive options. In select cases, neoadjuvant chemotherapy, followed by fertility-sparing surgery, may be explored, though this approach is still under clinical evaluation.

Who are ideal candidates for fertility-sparing treatment?

Not all patients are eligible. Ideal candidates are typically younger women with early-stage, low-grade tumours and a strong desire to preserve fertility. The decision depends on several factors, including the type of cancer, its stage and grade, the patient’s age and overall health. A thorough evaluation by a multidisciplinary team is essential to determine suitability.

What are the key considerations before opting for treatment?

Fertility-sparing treatment requires careful planning. A detailed pre-operative assessment is crucial to confirm the cancer’s stage and histological type. Patients must be counselled about the potential risks, including the chance of recurrence and the possibility that more aggressive treatment may be needed later. The goal is to balance cancer control with fertility preservation, and this must be done without compromising the patient’s safety.

What does long-term management involve?

Long-term follow-up is critical. Patients need regular monitoring through imaging, blood tests and biopsies to detect any signs of recurrence. If the cancer returns, more definitive treatment—such as hysterectomy or chemotherapy—may be necessary. Pregnancy is usually postponed until the patient has completed treatment and remains cancer-free for a recommended period. In cases where the uterus is preserved but the ovaries are not, assisted reproductive technologies and gestational carriers may be considered. Fertility-sparing treatment offers hope, but it must be pursued with caution, expert guidance and a clear understanding of the risks and benefits involved.