INTRODUCTION: Fertility-sparing treatment (FST) for patients with cervical cancer intends to achieve oncologic outcomes comparable to those after radical treatment while maximizing reproductive outcomes, including the ability to conceive and minimizing the risk of prematurity. METHODOLOGY: International multicentre retrospective FERTISS study focused on patients treated with FST analysed timing of FST relative to pregnancy, conception attempts and methods, abortion rates, prophylactic procedures reducing the risk of severe prematurity, pregnancy duration, and delivery mode. RESULTS: Of the 733 patients treated at 44 centres in 13 countries, 49.7% attempted to conceive during median follow-up of 72 months and 22.6% (166/733) patients achieved a successful pregnancy. Success rate was significantly higher after non-radical surgery (63.2%; 122/193) compared to radical trachelectomy (25.7%; 44/171, p < 0.001). Available perinatological data shows that 89.5% (111/124) of the patients became pregnant naturally. There was no significant difference in the abortion rate in the first pregnancy nor delivery success rates between non-radical and radical procedures patients. Preterm delivery (<38 weeks gestation) occurred more frequently after radical than non-radical procedures (76.5% vs. 57.7%, p = 0.15). Almost all patients (97.3%; 73/75) who underwent regular ultrasound cervicometry in pregnancy with subsequent prophylactic procedures delivered a live fetus, compared to 30.6% (15/49) women without such management, p < 0.001. CONCLUSION: Patients who underwent non-radical surgery had significantly higher pregnancy rates. Most pregnancies resulted in a viable fetus, but radical trachelectomy led to a higher rate of preterm births in the severe prematurity range. Half of the patients did not attempt pregnancy after FST.

1st Obstetrics and Gynecology Clinic George Emil Palade University of Medicine Pharmacy Science and Technology Târgu Mureș Târgu Mureș 540136 Romania

Claudius Regaud Institute University Cancer Institute Toulouse 31300 France

Department of Gynecology and Gynecologic Oncology Evangelical Clinic Essen Mitte Essen 45136 Germany

Department of Gynecology and Obstetrics University Hospital Brno and Masaryk University Brno 602 00 Czech Republic

Department of Gynecology and Reproductive Medicine University Hospital Jena Jena 07747 Germany

Department of Gynecology Breast Center Red Cross Clinic Munich Women's Clinic Munich 80634 Germany

Department of Gynecology Hungarian National Institute of Oncology Budapest 1122 Hungary; Doctoral School of Clinical Medicine University of Szeged Hungary

Department of Obstetrics and Gynecology Faculty of Medicine and Dentistry Palacky University University Hospital Olomouc Olomouc 779 00 Czech Republic

Department of Obstetrics Gynecology and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague 128 08 Czech Republic

Department of Surgical Oncology Institut Paoli Calmettes Marseille 13009 France

Department of Women and Child Health Division of Gynecologic Oncology Fondazione Policlinico Universitario A Gemelli IRCCS Catholic University of the Sacred Heart Rome Rome 00168 Italy

Department of Women's Health Tuebingen University Hospital Tuebingen 72076 Germany

Department of Women's Health Tuebingen University Hospital Tuebingen Germany; Gynecology Diakonie Klinikum Schwäbisch Hall gGmbH Schwäbisch Hall 74523 Germany

Fondazione IRCCS Istituto Nazionale Tumori Milan Milan 20133 Italy

Gynecologic and Breast Oncologic Surgery Department Georges Pompidou European Hospital Paris France; University Paris Cité Paris 75015 France

Gynecologic Oncology Department N N Alexandrov National Cancer Centre of Belarus Minsk 223040 Belarus

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