Malignant ovarian germ cell tumors (MOGCT) are a group of ovarian malignant tumors with different histological features that originate from primordial germ cells of the embryonic gonads. They include asexual cell tumors, immature teratomas, yolk sac tumors, embryonal carcinomas, primary choriocarcinomas, and mixed germ cell tumors, the first three being the most common. The overall 5-year survival rate of ovarian malignant germ cell tumors has increased from 20%-30% in the past to 80%-100% at present, so how to treat patients to preserve their reproductive function while ensuring survival rate has become the focus of clinicians’ attention. In this paper, we review the theoretical basis, surgical approach, postoperative adjuvant therapy and recovery of ovarian function in the treatment of ovarian malignant germ cell tumors. Fertility preservation surgery in MOGCT patients is recommended to perform adnexal resection on the affected side, preserving the uterus and the healthy ovary. The efficacy of ovarian cyst debridement alone needs to be confirmed by further studies. For patients with clinical stage II or higher, staged surgery including greater omentum, appendectomy and lymph node dissection or tumor cytoreductive surgery is feasible. Most scholars currently do not advocate biopsy of the contralateral ovary because of the possibility of peritoneal adhesions and premature ovarian failure ultimately leading to infertility. However, about 10% to 20% of asexual cell tumors involve both ovaries, and their staging can be a guide for further treatment, so biopsy should be performed even if the contralateral ovary does not show any abnormalities on exploration. Patients with normal uterus with bilateral ovarian involvement in MOGCT may be considered to have both ovaries removed to preserve the uterus if they have fertility requirements, and then to fulfill their fertility wishes through assisted reproductive technology after cure, but this treatment involves difficult techniques and complex ethical issues and is rarely performed.