Cervical, endometrial, and ovarian cancer are the most common gynecologic cancers in South Korea (hereafter, Korea) [1]. Cervical cancer is the most common, followed by endometrial and ovarian cancer [1]. In a major change in the epidemiology of gynecologic cancer in Korea, the incidence of cervical cancer is rapidly decreasing and the incidence of endometrial cancer and ovarian cancer is rapidly increasing [2]. Notably, although the incidence of cervical cancer is decreasing overall, the incidence of cervical cancer and endometrial cancer is increasing among young women [2]. In addition, as the birth rate falls and the average age at which women first give birth gradually increases, the incidence of gynecologic cancer among young women who have not yet undergone childbirth is also increasing [3]. Therefore, there has been a greater impetus in recent years on preserving fertility in young women with gynecologic cancer. For young women who have not undergone childbirth, the preservation of fertility after treatment for gynecologic cancer has a significant impact on their quality of life. For early-stage gynecologic cancers, fertility-sparing treatment makes future pregnancy possible by treating the cancer and leaving parts of the uterus and ovaries intact. For advanced gynecologic cancers, treatments that leave the uterus and ovaries intact are not always possible, and radiation therapy or chemotherapy, which can lead to infertility, are often required. Therefore, assisted reproductive technology is required to preserve fertility. This article describes methods for preserving fertility in young women with gynecologic cancer and examines practical issues and research trends related to oncofertility in gynecologic cancer.

The cure rate for stage I gynecologic cancers is very high, underscoring the need to focus on improving patients’ quality of life. Fertility preservation after gynecologic cancer treatment in young women who have not yet given birth to children is one of the major quality of life problems for this population. Guidelines for safe fertility-sparing management in women who want to become pregnant after treatment for gynecologic cancer have been established to some extent based on the results of numerous studies.

Surgical treatment for advanced gynecologic cancer can lead to situations in which the uterus and/or ovaries cannot be preserved. In addition, infertility can occur after radiation therapy or gonadotoxic chemotherapy. In this situation, thorough consultation before treatment is required for patients who wish to preserve fertility, and assisted reproductive technology is required.

If the ovaries should be removed surgically or pelvic radiation therapy or gonadotoxic chemotherapy is planned, a strategy to collect and store the patient’s eggs is needed before treatment. These methods include embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. Ovarian transposition can also be an option before pelvic radiation therapy. If the patient has a spouse, embryo cryopreservation is the most effective method [31]. However, it takes over 2 weeks for ovarian hyperstimulation, transvaginal ovum pick-up, and fertilization before cryopreservation of an embryo is possible [31]. In the absence of a spouse, oocyte cryopreservation can be performed [31]. Immediately after transvaginal ovum pick-up, the patient’s oocytes are frozen, but this process also takes over 2 weeks [31]. As of recently, ovarian tissue cryopreservation can also be performed [32]. One advantage of ovarian tissue cryopreservation is that no additional time is required to induce ovarian hyperstimulation, so there is no need to postpone anti-cancer treatment [32]. If these processes cannot be performed before treatment, ovum donation should be selected as the method for inducing pregnancy.

If the uterus has been removed, a surrogate mother can be used in family planning. The development of artificial uteruses and research in the field of uterine transplantation are in the beginning stages, and no conclusions can be drawn yet.

For women with gynecologic cancers, there are several ways to preserve fertility and perform childbirth after treatment. For women with early-stage gynecologic cancers, one method of doing so is to preserve parts of the uterus and ovaries. If the uterus and ovaries cannot be preserved, or radiation therapy and gonadotoxic chemotherapy are required, assisted reproductive technology can be used as a method to preserve fertility. If a woman diagnosed with gynecologic cancer wishes to preserve fertility in order to give birth after treatment, it is necessary to discuss these treatment options in detail before treatment.