There are still many problems and controversies in the treatment of endometrial cancer with preservation of fertility. First of all, there is the problem of diagnosis. Conservative treatment of endometrial cancer is only applicable to patients with pathology reported as type I endometrial cancer with highly differentiated cells and imaging reported as stage IA (no myometrial infiltration or lymph node metastasis, no distant metastasis, and no ovarian tumor). However, the diagnosis and assessment of patients’ disease before conservative treatment mainly relied on clinical and imaging examinations such as ultrasound and MRI, but there were inevitable limitations due to clinical examinations and these tests, for example, the sensitivity of MRI in detecting lymph node metastasis was only 50%, and the limitations of diagnostic techniques might lead to underestimation of tumor stage and missed detection of microinfiltrates, metastatic lesions, and ovarian tumors in some patients. Tumor progression occurs in 5-6% of patients even after highly effective progestogen therapy, which may be related to the underestimation of staging. Therefore, patients should be fully aware of the possibility of underestimation and delayed surgical treatment leading to progression before choosing fertility preservation treatment. Secondly, fertility preserving treatment for early endometrial cancer is a means of temporarily preserving the uterus for patients with fertility requirements. Compared with conventional staged surgery, conservative treatment has a lower rate of complete remission and a higher rate of tumor recurrence, with recurrence rates as high as 25%-67% after progestin therapy, and even up to 72% at 7 years. For these patients who do not respond to progestin therapy, those who repeatedly fail to assist in pregnancy or pregnancy, or those who successfully complete childbirth even after treatment, standardized staging surgery should be performed as early as possible to avoid tumor recurrence and progression.