Fertility Preservation in Female Cancer Patients: Comprehensive Clinical, Surgical, and Radiologic Guide for Radiologists.

Fertility preservation is a critical consideration for young women undergoing cancer treatment, particularly in cases of gynecologic malignancies. Various options are available and include fertility-sparing treatment (FST) procedures and fertility-preserving treatment (FPT) options such as oocyte or embryo cryopreservation, ovarian tissue cryopreservation, and surgical transposition of the ovaries or uterus. In cases of endometrial cancer, FST entails hysteroscopic resection or dilation and curettage, followed by high-dose progestin therapy for early-stage low-risk tumors. To be suitable for FST, at MRI the tumor must be confined to the endometrium, without myometrial or cervical stromal invasion and without evidence of metastasis. For cervical cancer, FST such as conization or trachelectomy, in combination with lymph node assessment, may be considered if the tumor is confined to the cervix and is 2 cm or smaller in diameter. MRI is pivotal for assessing the tumor extent, largest tumor size, depth of cervical stromal invasion, and proximity of the tumor to the internal os. For ovarian cancer, FST is feasible in select cases, including those of borderline tumors, stage IA low-grade epithelial cancers, and germ cell or sex cord stromal tumors. It often is associated with high survival rates that exceed 90% in cases of early-stage disease, although the risk of recurrence varies based on histologic factors. MRI is essential for characterizing and evaluating the extent of these tumors. A comprehensive approach with imaging, histopathologic analysis, and patient counseling combined is essential for developing personalized FST and suitable FPT protocols. This strategy ensures a balance between oncologic safety and effectiveness while respecting the patient's autonomy in making decisions about future reproductive choices. ©RSNA, 2026 Supplemental material is available for this article.