Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 2.4 of the Fer­ti­PRO­TEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.


To date, cervical cancer is the second most common cancer in women worldwide. Currently, one in two women is under 35 years of age at initial diagnosis. As a result of good cancer screening pro­grammes, one third of cervical cancers in Europe will currently be diagnosed in the early stage of FIGO I. About 80% of cervical cancer cases are squamous cell car­cino­mas. A second type, adeno­car­cinoma, par­tic­u­larly affects young women and this type is more difficult to detect by the screening methods which are available. Adeno­car­cinoma has a worse prognosis.

The tumour stage is one of the most important para­met­ers for estim­at­ing the prognosis in cervical cancer. In early stages, cervical cancer has a 5‑year survival rate of approx­im­ately 93%. Further clear pro­gnost­ic and risk factors for cervical cancer are lymph node involve­ment, tumour grade (i.e., to what degree the tumour tissue differs from normal tissue) and histology. Patients without lymph node involve­ment have a 5‑year survival rate of approx­im­ately 90%, whereas proven nodal involve­ment reduces the survival rate to 20–60%, depending on the location of the affected lymph nodes.

problems of fertility pre­ser­va­tion in the treatment of cervical carcinoma in situ (pre stage)

Surgical treatment of carcinoma of the cervix in situ does not sig­ni­fic­antly affect fertility. Newer surgical tech­niques reduce the negative effect on the closure function of the cervix in sub­sequent pregnancies.

cervical cancer

The treatment of cervical can have a sig­ni­fic­ant influence on fertility in many ways.


In early stages of cervical cancer, surgery is possible as a primarily a curative treatment, i.e. curative. The uterus and therefore fertility can only be preserved in early tumour stages up to maximum FIGO IB and a tumour size of<2 cm. At higher stages, the uterus must be removed and pregnancy is no longer possible.

Pre­ser­va­tion of the ovaries is aimed for if possible for in cervical cancer. In indi­vidu­al cases, ovarian-pre­serving surgery can also be performed for adeno­car­cinoma after a risk assess­ment (<FIGO IB2).

combined radiochemo­ther­apy

If combined pelvic radiochemo­ther­apy is necessary, the ovaries should be relocated out of the radiation field. Ovarian tissue can be removed at the same time for storage. The damaging effect of radio­ther­apy in the pelvic cavity depends on the total dose of irra­di­ation, the cal­cu­lated local dose to the ovaries and the age of the woman at the time of radio­ther­apy. The radiation dose in 97.5% of treated women aged 30 years who exper­i­enced complete ster­il­iz­a­tion was 14.3 Gy.

If irra­di­ation of more than 45 Gy impacts the uterus, the radiation-induced changes in the uterine tissue are not com­pat­ible with a later pregnancy. Even lower doses may adversely affect a pregnancy. A uterus trans­plant would then be an exper­i­ment­al approach.

Combined chemora­dio­ther­apy typically consists of platinum-con­tain­ing regimens for sens­it­isa­tion. The damaging effect on the ovaries is poten­ti­ated by sim­ul­tan­eous irra­di­ation of the pelvis.Bei der kom­bin­ier­ten Radiochemo­ther­apie werden typis­cher­weise zumeist Platin-haltige Schemata zur Sens­ib­il­is­ier­ung genutzt. Der die Eier­stöcke schädi­gendeEf­fekt poten­ziert sich mit der gleichzeit­i­gen Bestrahlung des kleinen Beckens.


Currently, chemo­ther­apy is only used exper­i­ment­ally at higher stages in indi­vidu­al cases to enable the uterus to be preserved.  Ovarian tissue can also be removed during the lap­aro­scopy which is performed prior to the start of chemo­ther­apy to remove lymph nodes.

In higher stages, active fertility pre­ser­va­tion is not sensible and jeop­ard­izes the chances of cure.

risks of fertility pre­ser­va­tion treatment

Meta­stas­is of early cervical cancer to the ovaries is rare and is rather found in higher tumour stages. Nev­er­the­less, there is an increased risk of meta­stas­is to the ovaries in young women with adeno­car­cinoma, which has already even been described for carcinoma in situ. This must be con­sidered when pre­serving the ovaries.

The relo­ca­tion of the ovaries out of the pelvis can also con­trib­ute to a reduction in the ovarian reserve as a result of dis­rup­tion to the blood supply.

practical apprioach if fertility pre­ser­va­tion is considered

Fertility-pre­serving surgery is possible in a patient who wishes to conceive and has newly diagnosed early cervical cancer FIGO IA1 with risk factors or up to IA2 without risk factors. However, the increased risk of relapse in isolated cases must be considered.

Relo­ca­tion of the ovaries out of the pelvis can be performed before planned pelvic radio­ther­apy. Ovarian tissue can be sim­ul­tan­eously removed for cryo­p­reser­va­tion during this procedure.

Chemo­ther­apy for cervical carcinoma in higher stages to allow fertility pre­serving surgery is very con­tro­ver­sial and should be clas­si­fied as experimental.