According to the specific situation of China, drawing on the experience of ASCO in formulating clinical guidelines for the preservation of reproductive function, summarizing and analyzing important documents in relevant databases, and reaching consensus through full discussion among experts in gynecologic oncology, reproductive medicine, and gynecologic endocrinology, China’s first clinical guideline for the preservation of reproductive function of gynecologic malignant tumors has been formulated. The formulation of this guideline can provide an important basis for clinicians to make decisions and better serve patients; at the same time, it can also educate and guide patients with relevant medical knowledge and encourage them to actively participate in multicenter clinical trials, which plays a positive role in promoting the improvement of treatment options for fertility preservation of gynecologic malignant tumors in China. I. Treatment of gynecological malignant tumors with preservation of fertility function (I) Cervical cancer With the popularization of cervical cancer screening, the number of early-stage patients has increased, and their age tends to be younger, and with the opening up of national family planning policy, many young patients with cervical cancer aspire to preserving their fertility function. Surgery is the main treatment for cervical cancer to preserve reproductive function. Cervical conization: The indications for cervical conization are: (1) stage Ia1 and stage Ia2 squamous cervical cancer; (2) stage Ia1 adenocarcinoma of the uterine cervix. It has been reported in the literature that early stage invasive carcinoma of the uterine cervix can be successfully treated by conization of the uterine cervix as long as the depth of infiltration is less than 3 mm and there is no lymphovascular space involvement. Precautions: (1) Positive margins, lymphovascular space involvement, interstitial involvement of the cervix and multicentricity of the lesion are the decisive factors for residual or recurrent lesions after cervical conization. Therefore, the results of postoperative pathologic examination must clearly indicate these 4 aspects, which is the basis for formulating the patient’s postoperative management plan after cervical conization. (2) In order to avoid residual lesions, the appropriate range of conization should be selected according to the patient’s age, colposcopic findings and the pathologic type of the tumor. In general, the width of resection should be 0.3 cm outside the lesion, and the cone height should be extended to 2.0-2.5 cm of the cervical canal, and the squamocolumnar junction must be resected together during conization. (3) For cervical microinvasive carcinoma with positive margins, the International Federation of Gynecology and Obstetrics (FIGO) recommends that another biopsy of the cervix should be performed or the cervical cancer should be treated as stage Ib1 cervical cancer. (4) For patients with stage Ia1 cervical cancer with lymphovascular space involvement and stage Ia2 cervical cancer, pelvic lymph node dissection should be performed at the same time, and if accompanied by vaginal intraepithelial neoplasia at the same time, part of the affected vagina should be resected. 2. Wide cervical resection: Wide cervical resection (radical trachelectomy) can be performed through vaginal, open and laparoscopic procedures, and its biggest advantage is that it can treat cervical cancer while preserving the fertility of patients. Indications of radical trachelectomy: (1) young patients who desire to have children; (2) patients do not have infertility factors; (3) tumor ≤2 cm; (4) clinical stage Ⅰa2～Ⅰb1; (5) squamous carcinoma or adenocarcinoma; (6) colposcopy does not find tumor infiltration over the inner mouth of the uterine cervix; (7) no metastasis of regional lymph nodes is found. Precautions: (1) Define the pathologic diagnosis and clinical staging of uterine cervical cancer before surgery, carry out precise assessment, and strictly grasp the indications for surgery. (2) Wide excision of the cervix is only suitable for early stage cervical cancer, while patients with cervical cancer of stage Ib2 or above whose tumors are >2 cm and/or involve blood vessels and lymphatic vessels are prone to recurrence after surgery, and should not be subjected to wide excision of the cervix in principle. (3) It is important to determine the size of the cervical tumor, the relationship between the tumor and the internal orifice of the cervical canal and whether there is infiltration in the myometrium of the lower segment of the uterus before operation, and MRI examination should be applied to measure and evaluate the tumor, which has an accuracy rate of 96.7%. (4) Intraoperative frozen pathologic examination should be performed routinely and its accuracy should be ensured as much as possible. The results of the pathologic examination of pelvic lymph nodes and cervical margins are of guiding significance for whether or not to perform fertility preservation treatment. (5) Follow-up of pregnancy after surgical treatment for fertility preservation. Postoperative follow-up: patients should be followed up monthly in the first six months after surgery, including gynecological examination, ultrasound examination and serum squamous epithelial cell carcinoma antigen (SCC-Ag) level detection, and if necessary, CT, MRI and positron emission tomography (PET)-CT examination are feasible. If there were no abnormalities, follow-up visits were made every 2 months thereafter; every 3 months after 1 year; and every 6 months after 3 years. Cervical cytology was performed every 3 months, and if both cytologic examinations were negative, the patient could be advised to become pregnant. Most scholars suggest that pregnancy can be achieved after 6 months after surgery. If natural conception fails, assisted reproductive technology can be considered. 3.Preservation of ovary problem: The ovarian metastasis rate of early cervical cancer is very low, among which the ovarian metastasis rate of squamous carcinoma of the cervix is <1< span="">%, and that of adenocarcinoma of the cervix is about 10%. Clinical data also show that there is no clear relationship between sex hormones secreted by the ovary and the development of squamous cervical cancer. Therefore, patients with early squamous carcinoma of the uterine cervix can routinely preserve both ovaries during surgery, while patients with early adenocarcinoma of the uterine cervix routinely have both ovaries removed. Indications for ovarian preservation: (1) pathological type of squamous carcinoma of the uterine cervix; (2) patient age ≤ 45 years; (3) tumor ≤ 2 cm; (4) no tumor infiltration of the uterine corpus and paracervical tissues; (5) no clear lymph node metastasis. For patients with cervical cancer requiring pelvic radiotherapy . The ovaries can be surgically (open or laparoscopic) relocated to a site outside the pelvic radiation field before radiotherapy. It is often fixed in the lateral groove of the colon, below the transverse colon, in order to preserve the endocrine function of the ovary, which is conducive to improving the patient’s quality of life after treatment. Biopsy and rapid frozen pathology of both ovaries should be performed and confirmed to be free of tumor metastasis before ovarian translocation. (II) Endometrial cancer With the changes of women’s life style and diet structure in China, the incidence of endometrial cancer is on the rise. For young patients with endometrial cancer, treatment with high-dose high-efficiency progesterone to preserve reproductive function has been proved to be an effective treatment option. 1. Indications: (1) Patients are ≤40 years old; (2) have strong reproductive requirements; (3) the pathological type is endometrioid adenocarcinoma; (4) the degree of pathological differentiation is highly differentiated; (5) the lesions are confined to the endometrium without myometrial infiltration, extra-uterine spread, or lymph node involvement; (6) the expression of PR is positive (applicable for those with progesterone therapy)); (7) patients do not have contraindications to progesterone therapy ( applicable to progestin therapy); (8) patients were fully informed and able to comply with treatment and follow-up. Pre-treatment evaluation: (1) history taking: detailed inquiry about menstruation, marriage and childbearing history; previous treatment process and treatment response; history of complications, such as polycystic ovary syndrome (PCOS), infertility, diabetes mellitus, hyperlipidemia and so on. (2) Physical examination and assessment of general condition: including height, body mass, body mass index (BMI), etc.; gynecological examination; normal complete blood count; normal liver and renal function; normal coagulation function; normal electrocardiogram; chest radiographs except for lung metastasis, hydrothorax, tuberculosis, lung cancer. (3) Pathological diagnosis review: review by senior gynecologic tumor pathologist; pathological type is endometrioid adenocarcinoma, degree of pathological differentiation is highly differentiated, immunohistochemical staining PR is positive. (4) Assessment of disease extent: ① no myometrial infiltration: transvaginal ultrasound (TVUS) or pelvic MRI; ② no concomitant ovarian malignancy: serum CA125 level test and TVUS, and laparoscopy and biopsy if necessary; ③ no pelvic lymph node involvement: pelvic CT, MRI, and PET-CT or laparoscopy and biopsy if necessary. Informed consent: explain in detail to the patient the advantages and disadvantages of surgical treatment and drug conservative treatment; explain the process of fertility preservation treatment, drug side effects and the risk of disease progression; ensure that the patient fully understands the treatment process and risks, and is able to adhere to the completion of the treatment and follow up; and give the patient sufficient time for consideration and counseling, and start the treatment after he/she voluntarily chooses the conservative treatment and signs the informed consent form for the treatment. 3.Treatment methods: (1) High-dose high-efficiency progesterone treatment: ①Drug choice: megestrol tablets, continuous oral, 250-500 m/d; or medroxyprogesterone tablets, continuous oral, 160-480 m/d. ②Dose adjustment: during the treatment period can be based on the presence or absence of vaginal bleeding, the endometrial thickness of the endometrium changes in the above dosage range of increase or decrease in the dose. (2) Other therapeutic methods: for patients with obesity, liver function abnormalities and other contraindications to progesterone therapy, rarely used alone, mostly a combination of two methods. ① gonadotropin-releasing hormone agonist (GnRH-a); ② levonorgestrel intrauterine sustained-release system (LNG-IUS); ③ aromatase inhibitors, such as letrozole. (3) Systemic comprehensive treatment of comorbidities: ① Weight loss, lipid lowering: knowledge education, diet control, exercise guidance; ② Diagnosis and treatment of diabetes mellitus. 4, side effects monitoring: (1) possible side effects: increased body mass, irregular vaginal bleeding, breast distension, decreased appetite, nausea and vomiting, skin rash, thromboembolic disease. (2) Monitoring methods: observing the above symptoms, measuring body mass every month, determining liver and kidney functions, measuring endometrial thickness by transvaginal ultrasonography, observing ovary size. (1) Timing and method of evaluation: 3 months of continuous drug treatment for a course of treatment, every 3 months routine ultrasound and/or MRI to assess the size of the uterus, the thickness of the endometrium and the presence of myometrial infiltration, to understand the pelvic and abdominal cavity and other organs such as the ovaries; hysteroscopy or diagnostic scraping to obtain the endometrial tissue sent to the pathology of the examination. (2) Criteria for determining the efficacy of treatment: ① complete remission: complete regression of endometrium after treatment, interstitial metaplasia, no endometrial hyperplasia or cancerous foci; ② partial remission: endometrial lesions of lower grade or residual cancerous foci, accompanied by glandular degeneration and atrophy; ③ non-response or stabilization of the disease: no changes in endometrium after treatment, residual cancerous foci, no degeneration or atrophy of endometrium; ④ disease progression: endometrial cancer patients with clear myometrial infiltration; ④ disease progression: patients with clear myometrial infiltration, no myometrial infiltration; and ⑤ endometrial cancer patients with clear myometrial infiltration. Disease progression: patients with endometrial cancer have clear myometrial infiltration or extra-uterine lesions. Indications for termination of drug therapy: drug therapy can be terminated if any of the following conditions are met. (1) There is definite evidence of myometrial infiltration or extra-uterine lesions, i.e. disease progression. (2) The patient no longer requires preservation of reproductive function. (3) Efficacy assessment has reached complete remission (stop treatment or consolidate treatment for 1 course of treatment as appropriate). (4) Serious side effects have occurred and treatment cannot be continued. (5) Continuous treatment for 6 months, the tumor does not respond. Follow-up and subsequent treatment: (1) Those who do not have reproductive requirements for the time being: the purpose of treatment is to maintain regular menstruation and prevent recurrence. ①Treatment targets: those who have completed high-dose progesterone treatment and obtained complete remission; those who are unmarried or divorced; and those who have given birth. ②Treatment: If you have natural menstruation, observe and measure your basal body temperature. If there is no natural menstruation or basal body temperature monitoring suggests anovulation, give oral progesterone ≥12 d/month, and then withdrawal bleeding; or oral short-acting contraceptive pills, regular monthly withdrawal bleeding; or intrauterine implantation of LNG-IUS; if you have already given birth to a child, give the uterus an intrauterine implantation of LNG-IUS, or surgical resection of the uterus. (iii) Condition monitoring: regular follow-up every 3-6 months, recording menstruation, pelvic ultrasound to detect endometrial condition, if there is abnormal thickening of endometrium or space-occupying lesion, irregular vaginal bleeding, perform diagnostic scraping to know the endometrial condition. (2) Those who urgently want to have children: the purpose of their treatment is to monitor ovulation and actively assist pregnancy. ①History of infertility: perform infertility examination, including semen routine, uterine iodine oil imaging and whether there are ovulation disorders, etc. If any abnormality is found, individualized treatment will be performed according to the cause and degree of infertility. If any abnormality is found, individualized treatment will be carried out according to the cause and degree of infertility: if no abnormality is found, ovulation will be monitored, pregnancy will be expected, and those who are still infertile will be assisted in pregnancy by assisted reproductive technology. ②No previous history of infertility: observe the natural cycle of menstruation recovery, monitor the basal body temperature to understand the ovulation situation, ovulation for natural pregnancy, if found no ovulation or ovulation but still no natural pregnancy for 6 months, into the above infertility checkups and treatment process. (iii) Condition monitoring: the method is the same as before. (III) Ovarian malignant tumor Ovarian malignant tumor is a type of gynecological malignant tumor with the highest morbidity and mortality rate. Different pathological types of ovarian malignant tumors have different clinical manifestations, and the treatment and prognosis are not the same. Whether ovarian malignant tumors are feasible for surgical treatment with preservation of fertility depends on the patient’s age, pathological type and surgical pathological staging. 1. Ovarian epithelial cancer: patients with ovarian epithelial cancer (ovarian cancer) should take a cautious attitude towards fertility preservation treatment. They must be strictly selected, explain the advantages and disadvantages as well as the risks of fertility preservation treatment to the patients and their family members, strive for their understanding and consent, and sign the treatment consent form. Surgery for ovarian cancer with fertility preservation can only be performed if the following conditions are met: (1) the patient’s age is <35< span=""> years old and desires to have children; (2) the surgical pathological stage is stage Ia; (3) the degree of pathological differentiation is highly differentiated; (4) the appearance of the contralateral ovary is normal, and the pathology examination is negative after biopsy; (5) the cytology of the abdominal cavity is negative; and (6) ” high-risk areas” (including the uterorectal recess, lateral colonic groove, mesentery, greater omentum and retroperitoneal lymph nodes) exploration and multipoint biopsy are negative; (7) with follow-up conditions; (8) after the completion of childbearing and, if appropriate, then hysterectomy and contralateral adnexectomy. Malignant germ cell tumors of ovary: (1) Surgery for preserving fertility: as a basic principle of treatment for malignant germ cell tumors of ovary, it is not limited by the stage. Rationale: most ovarian malignant germ cell tumors are unilateral; recurrence is also rarely in the contralateral ovary and uterus; sensitive to cisplatin + etoposide + bleomycin (PEB), cisplatin + vincristine + bleomycin (PVB) regimen of chemotherapy; resection of the contralateral ovary and uterus does not improve the patient’s prognosis. (2) Surgical scope: adnexectomy on the affected side, preserving the contralateral normal ovary and uninvaded uterus, removing the metastatic lesions as cleanly as possible, supplemented with chemotherapy after surgery, but need to pay attention to the toxic effect of chemotherapy on the ovary, and carry out ovarian protection. For early stage ovarian anaplastic cell tumor and grade I immature teratoma, in addition to adnexectomy of the affected side, comprehensive staging surgery including salpingo-oophorectomy and retroperitoneal lymph node dissection should be carried out. If the surgical pathological stage is confirmed to be stage Ia1, chemotherapy can be withheld after operation. Ovarian junctional tumor: (1) Unilateral ovarian junctional tumor: for young patients <40 years old, usually perform adnexectomy on the affected side to preserve the reproductive function. Staging surgery is not recommended for early-stage patients because too large a surgical scope can cause pelvic adhesions and lead to postoperative infertility; moreover, early-stage patients almost do not need postoperative chemotherapy. (2) Bilateral ovarian junctional tumor: its incidence is 38%, as long as there are normal ovarian tissues present, it can also be performed only tumor excision to preserve the reproductive function. (3) Late-stage ovarian junctional tumors: as long as the contralateral ovary and uterus are not involved. Without exophytic papillary structures and infiltrative implantation, fertility preserving treatment can also be considered. Since most patients with ovarian junctional tumors are young, they are prone to recurrence after surgery and are tricky to manage. Therefore, the pros and cons and risks of fertility preservation treatment must be explained to the patients and their families before treatment to gain their understanding and consent, and to sign a treatment consent form. (D) Gestational trophoblastic tumors It is a clinical consensus that the treatment of gestational trophoblastic tumors with preservation of fertility function is based on the following principles: (1) Trophoblastic tumors mainly occur in women of childbearing age, and the treatment is mainly based on chemotherapy. (2) Preservation of reproductive function is a basic principle in the treatment of trophoblastic tumors. (3) For patients with advanced trophoblastic tumors with distant metastases, including neurological metastases, as long as the treatment results are satisfactory, their reproductive function can be preserved. (4) The incidence of abortion, fetal malformation and obstetric complications caused by chemotherapy in patients with trophoblastic tumors is not significantly higher, and the rate of chromosomal aberrations in newborns born to cured patients with long-term follow-up is not significantly different from that of the normal population. Second, gynecologic malignant tumors to preserve fertility-related reproductive endocrine therapy This part of the treatment should be reproductive endocrinology experts, however, gynecologic oncologists should be involved in the development of treatment plans and patient follow-up. Although the perception of the risk of permanent amenorrhea after radiation and chemotherapy has not changed much in recent years, evolving and refined techniques for fertility-preserving treatments may play a decisive role in formulating clinical decisions for patients. Reproductive endocrine therapies associated with the preservation of fertility function in gynecologic malignancies include embryo cryopreservation, oocyte cryopreservation, ovarian suppression, and ovarian tissue cryopreservation and transplantation. Options for preserving fertility depend on the patient's age, pathologic diagnosis, treatment, whether or not the patient is married, and the wishes of the individual patient and family. Because some reproductive endocrine treatment options may delay tumor treatment, early referral to a gynecologic oncologist should be emphasized to minimize the risk of delayed tumor treatment. Embryo cryopreservation: Embryo cryopreservation is the most mature and successful method of preserving reproductive function. Cryopreservation of embryos remaining after in vitro fertilization has been routinely used in clinical practice for a long time and has a high success rate. Although day 3 of the menstrual cycle is the ideal time for pharmacologic stimulation of the ovaries, recent studies have found that stimulation of the ovaries at any time of the menstrual cycle can be successful. In addition, letrozole or tamoxifen are equally effective compared to conventional drugs and should be the drug of choice for ovarian stimulation in patients with hormone-sensitive tumors. Aromatase inhibitors (e.g., letrozole) are primarily used in the adjuvant treatment of hormone-sensitive breast cancer (premenopausal women) and have the ability to both stimulate the ovaries and suppress estrogen levels. As a result, letrozole has been used within the last decade for ovulation induction in infertile patients, as well as for ovarian stimulation in patients with hormone-sensitive tumors in preparation for oocyte or embryo cryopreservation (note: reproductive use of letrozole is an over-the-counter indication for use and is limited to clinical studies). In combination with conventional drugs, letrozole increases ovarian stimulation and maintains estrogen at relatively low levels. The procedure involves ovarian stimulation and egg retrieval prior to chemotherapy or surgery, conventional in vitro fertilization or intracytoplasmic monosperm injection of oocytes and sperm after processing of the oocytes and sperm, in vitro culture of the fertilized eggs and embryos and evaluation of their development, and freezing of the well-developed embryos for storage and embryo transfer after completion of chemotherapy. Studies have shown that this route results in similar numbers of oocytes, embryos, and pregnancy outcomes as conventional therapy. Short-term follow-up studies have shown no significant effect on the patient's tumor-free survival time. 2. Oocyte cryopreservation: Oocyte cryopreservation is also one of the treatment options available, especially for unmarried (including prepubescent) patients who do not want to use donor sperm, who are temporarily unwilling to use their husband's sperm, or who have religious ethical considerations regarding embryo freezing. Previously, oocyte cryopreservation was only clinically tested in treatment centers with relevant experience and was divided into immature oocyte cryopreservation and mature oocyte cryopreservation. The immature oocyte in vitro maturation technique can be used in patients who are unsuitable or unwilling to undergo hormonal pharmacologic stimulation, either by ultrasound-guided puncture to obtain immature oocytes at any time during the menstrual cycle or by searching for immature oocytes during thin sectioning of ovarian tissues for freezing, culturing and maturing in vitro, and then freezing and preserving them. And the mature oocyte cryopreservation technique, with its significantly improved success rate, since October 2012 . The American Society for Reproductive Medicine (ASRM) has recognized that the technology is no longer limited to the clinical trial stage. Some assisted reproduction research centers have reported success rates for mature oocyte cryopreservation that are comparable to those of fresh oocyte technology, especially in younger women. Mature oocyte cryopreservation requires pharmacological stimulation of the ovaries and ultrasound-guided egg retrieval, and there are currently a wide range of ovarian stimulation regimens available. Stimulation can begin at any time depending on follicular status and is no longer dependent on the menstrual cycle, i.e., the acquisition of oocytes can be non-menstrual cycle-dependent, and ovarian stimulation can be initiated as early as possible in comparison with traditional stimulation regimens to shorten delayed oncologic treatment. Oocyte cryopreservation is significant for unmarried women who do not want to use donor sperm. One meta-analysis showed a 21% live birth rate using this method. Recent studies have shown that the probability of congenital anomalies in newborns obtained using oocyte cryopreservation is similar to that of natural pregnancies or pregnancies using fresh oocytes, but further studies are needed on the damage to oocytes caused by low temperatures, and on the toxic effects of antifreeze protectants. In addition, China's current regulations on assisted reproduction do not clarify the use of unmarried women's oocytes for assisted reproduction technology, and further improvement of the relevant regulations is needed to meet the needs of social development. Ovarian displacement: Ovarian displacement can be considered when tumor treatment involves pelvic radiotherapy. However, due to radiotherapy scattering and reduced blood supply to the displaced ovaries, the function of the displaced ovaries may not always be well protected, and patients should realize that this treatment option may not always be effective. In addition, repositioning of the displaced ovary may occur, so this technique should be performed as close to the start of radiotherapy as possible. The endocrine function of the ovaries should be checked regularly after ovarian translocation. 4. Ovarian suppression: Currently, there is a lack of valid supporting evidence on the exact effect and clinical value of GnRH-a and other ovarian suppression techniques in fertility preservation therapy. There is still much controversy about whether GnRH-a is effective in protecting ovarian function. Patients should be encouraged to actively participate in clinical trials related to the use of GnRH-a during chemotherapy to further clarify its clinical value. 5. Ovarian tissue cryopreservation and transplantation: Ovarian tissue is cryopreserved before treatment in women of childbearing age, and then frozen ovarian tissue is transplanted into the patient after completion of tumor treatment and before preparation for childbearing. This technique is not dependent on ovarian stimulation and sexual maturation, and is therefore the only option for pediatric patients. This technique is still considered to be in clinical trials and can only be performed in research centers with relevant experience, subject to ethical committee review and follow-up for tumor recurrence. To date, more than 19 live births have been reported. Whether the transplanted ovarian tissue will reintroduce tumor cells remains the biggest concern and the most feared issue with this technique, depending mainly on the primary site of the tumor, the type of pathology and the surgical pathology staging, and no tumor recurrence has been reported. Therefore, cryopreservation of human ovarian tissue must be strictly controlled for its indications for use. Treatment of estrogen-sensitive tumors: The biggest concern for estrogen-sensitive gynecologic malignancies is whether interventions to preserve fertility (e.g., stimulating the ovaries by increasing exogenous estrogen) and/or subsequent pregnancies will increase the risk of tumor recurrence. Ovarian stimulation regimens using aromatase inhibitors (e.g., letrozole) may reduce this concern, and some studies have shown that pregnancies obtained with this regimen do not increase the risk of tumor recurrence. 7, Other considerations: (1) BRCA gene mutation carriers, especially those with the BRCA1 gene mutation, have lower reserve function of the ovaries, poor response to ovulation induction, and are more prone to chemotherapy-induced infertility. These gynecological malignant tumor patients should be given great importance when consulting the question of "whether chemotherapy causes infertility". (2) For patients with familial hereditary tumors, the use of oocyte or embryo cryopreservation may be more beneficial, because embryo biopsy can detect the corresponding gene mutations, and pre-transplantation genetic diagnosis can also provide important clues and evidence. (3) An oncofertility (oncofertility) expert group should be formed, including experts in gynecologic oncology, radiotherapy, pathology, gynecologic endocrinology and reproductive medicine, to jointly formulate diagnosis and treatment plans, which should be based on the patient's anatomical location of the tumor, pathological type, staging, fertility status, lifestyle, risk of infertility after treatment and probability of tumor recurrence, etc., and should be integrated to develop an individualized The guidelines are not sufficient. III.Deficiencies of the guidelines Given the limitations of the literature, the literature search only retrieved 18 randomized clinical trials in treatment centers, 6 systematic reviews, meta-analyses, and previous guidelines, and a larger number of narrative reviews, case series analyses, and commentaries. There is a lack of large and/or randomized controlled clinical trials of fertility preservation in gynecologic oncology. Most of the available data are from cohort studies, case series analyses, and small non-randomized clinical trials with weak evidence of evidence-based medicine. Because multicenter clinical studies of fertility-preserving treatments for patients with gynecologic malignancies are in their infancy, the evidence still appears insufficient for determining whether interventions are effective, for evaluating efficacy in terms of a combination of tumor control and reproductive outcomes, and for recognizing long-term health problems in offspring. The positive and negative effects (both physical and psychological) of fertility preservation interventions are also underappreciated and underarticulated. Therefore, large and/or randomized controlled clinical trials should be strengthened to obtain high-level evidence-based medical evidence as early as possible to revise guidelines and serve the clinic.