Fertility Preservation After Gynaecological Cancer: What to Know

By Dr. Jessie Wai Leng Phoon, MRCOG
Medical Director, GenPrime Fertility Singapore
Last reviewed: January 2026

Hearing the words “gynaecological cancer” can flip your world upside down—especially if you still hope to have children someday. One of the most common questions people ask early on is simple, but heavy:

“Will this treatment take away my chance to have a family?”

The good news is that, for some selected early-stage cancers and precancers, there may be safe options that treat the condition while still leaving room for future pregnancy. This area of care is called oncofertility—where cancer care and fertility care are planned together, early.

This article translates clinical experience published in the Singapore Medical Journal into clear, patient-friendly guidance for individuals and couples navigating fertility decisions after a gynaecological cancer diagnosis.

What is oncofertility (and why timing matters)?

Oncofertility focuses on protecting fertility before or alongside cancer treatment. Timing is critical, because treatments such as removal of the uterus or ovaries, or certain chemotherapy regimens, can permanently affect fertility.

An oncofertility approach typically involves:

• A gynaecological oncologist (cancer specialist)
• A reproductive medicine specialist (fertility specialist)
• Coordinated counselling so fertility discussions happen early—not after treatment has already started

The goal is not to promise pregnancy, but to make sure patients understand what is medically safe, what options exist, and what decisions may be time-sensitive.

Can fertility be preserved with endometrial (uterine) cancer?

For some young women with early-stage endometrial cancer or precancerous conditions, fertility-sparing treatment may be an option. This is only considered in carefully selected cases and requires close monitoring.

What fertility-sparing treatment may involve

Depending on individual factors, treatment may include:

• Hormonal therapy using progestins
• A combination of oral medication and a hormone-releasing intrauterine system
• In selected cases, hysteroscopic removal of the tumour

What outcomes looked like in clinical experience

In the oncofertility clinic experience described in Singapore:

• Around two-thirds of women on fertility-sparing treatment had the cancer clear on follow-up
• Some women had persistent disease or regression to a precancerous state
• Recurrence can occur, which is why structured follow-up and planning for pregnancy timing are essential

Because recurrence risk increases with time, many patients are advised not to delay pregnancy once the cancer has cleared—sometimes using IVF to shorten the time to conception.

Fertility-sparing surgery for ovarian cancer

For selected ovarian cancers, it may be possible to treat the cancer while preserving fertility.

This often involves:

• Removing one ovary and fallopian tube, while keeping the uterus and the other ovary when safe
• Surgical staging to ensure the cancer has not spread

In the clinic’s experience, fertility-sparing surgery was performed in the majority of ovarian cancer cases where it was considered oncologically appropriate. Some women conceived spontaneously, while others used assisted reproductive treatments.

Borderline ovarian tumours and fertility

Borderline ovarian tumours (BOT) often affect younger women and require careful counselling.

Surgical options may include:

• Cystectomy (removing the cyst while preserving the ovary)
• Unilateral salpingo-oophorectomy (removal of one ovary and tube)

Each option has trade-offs between recurrence risk and preservation of ovarian reserve. A joint oncofertility consultation helps patients understand these differences clearly before surgery.

Egg freezing vs embryo freezing before cancer treatment

When treatment may affect fertility, preservation options include:

Egg freezing

• Does not require sperm
• Often chosen by single women or those who want flexibility

Embryo freezing

• Requires sperm and may offer more certainty about fertilisation
• Subject to local legal and regulatory requirements

Ovarian tissue freezing

• Reserved for specific situations where ovarian stimulation is not possible

Availability, cost, and eligibility vary by country, so personalised counselling is important.

What is AMH and why is it checked?

Anti-Müllerian hormone (AMH) is commonly used as a marker of ovarian reserve. Oncofertility teams may recommend:

• A baseline AMH test before ovarian surgery or treatment
• Repeat testing over time to understand how treatment affects fertility potential

AMH does not predict pregnancy on its own, but it helps guide informed decision-making.

What an oncofertility clinic does differently

A dedicated oncofertility clinic:

• Brings cancer and fertility specialists into the same conversation
• Coordinates timing between cancer treatment and fertility preservation
• Improves access to fertility services
• Reduces decisional regret by ensuring patients feel informed early

Many patients report greater clarity and confidence when fertility discussions happen as part of cancer care, rather than as an afterthought.

Questions to ask your doctor

If fertility matters to you now—or might in the future—consider asking:

• Is my condition suitable for fertility-sparing treatment?
• Do I need to decide about egg or embryo freezing before treatment starts?
• How will I be monitored during and after treatment?
• When would you advise trying for pregnancy?
• Should I test AMH or ovarian reserve now?
• What legal, cost, or timing considerations apply where I live?

A simple next step

You don’t need to decide everything at once. But if preserving fertility matters to you, one step can make a difference:

Ask for an oncofertility consultation as early as possible—ideally before treatment begins.

That conversation can clarify what is safe, what is possible, and what a realistic plan might look like for you.