Introduction/Background Immature teratomas (ITs) are a rare disease representing about one-third of all malignant ovarian germ cell tumors. They are frequently diagnosed in young women, with a peak at 15–30 years old, when the childbearing desire is not completed. Thus, fertility-sparing surgery (FSS) is the treatment of choice, followed by adjuvant chemotherapy (CT) in patients with high-risk features. We investigated the effect of CT on fertility outcome in stage I any grades ITs, also focusing on the effect of the type of ovarian surgery (unilateral salpingo-oophorectomy (USO) vs cystectomy (Cy)) on the same outcome.

Methodology Clinicopathological data were retrospectively collected and analyzed from a cohort of 74 patients with stage I ITs treated at San Gerardo Hospital (Monza, Italy). Forty-seven patients who manifested pregnancy desire and underwent a FSS were enrolled.

Results Among the 47 patients included 37 patients (78,7%) reached pregnancy. The pregnancy rate was not significantly different neither between adjuvant CT and surveillance group (62.5% and 82.0%, respectively [p = 0.21]), nor between USO vs Cy group (79,4% and 76,9%, respectively [p = 0.57]). The only statistical significant difference was found for staging (a decrease in pregnancy rate from 86.5% for stage IA to 50.0% for stage IC [p = 0.02]), but no factors reached a significant impact on the fertility outcome in a multivariate analysis. Interestingly, 62,5% of patients who relapsed reached a pregnancy.

Conclusion These data confirm that a fertility sparing approach is feasible in this young population, and the fertility outcome does not depend on surgical approach or post-surgical treatment. More prospective data are needed, and the role of stage of disease must be fully investigated.