Objectives The choriocarcinoma is the most frequent and chemo-sensitive of the malignant gestational trophoblastic tumors. The main management challenge in young patients is to balance a fertility-sparing therapy with good survival rates and quality of life. The aim of this work is to evaluate the fertility of young women with choriocarcinoma after a fertility-sparing strategy.

Methods We conducted a retrospective study of a prospective mono-centric database over a 20 year period (2000–2019) in the Tunisian Central Cancer Registry, the department of gynecology and Obstetrics, and the reproductive medicine unit in Farhat Hached Teaching Hospital in Sousse Tunisia. We collected all the pathology established cases of choriocarcinoma diagnosed in women under 40.

Results The cohort of 30 women included 18 (60%) who had a fertility-sparing therapeutic strategy and 12 (40%) who underwent hysterectomy ( all cases before 2010). There was no statistical difference between the fertility-sparing management group and the hysterectomy group in OS and DFS (respectively, P=0.09 and P=0.14). Among the fertility-sparing management group, 16 patients reported a pregnancy desire in the year following the diagnosis and stopped contraception in order to conceive. Twelve pregnancies in 5 patients were recorded with 4 live births.

Conclusions The use of less-toxic chemotherapy protocols is a good option when dealing with fertility sparing strategy in managing choriocarcinoma in young women especially that the recommended standards have shifted to no surgery.