Cervical cancer often affects women of reproductive age, for whom treatment may compromise both fertility and ovarian endocrine function. Fertility-sparing surgery may preserve the ability to achieve pregnancy, whereas Ovarian Preservation (OP) during hysterectomy and Ovarian Transposition (OT) before pelvic radiotherapy may prevent treatment-induced premature ovarian insufficiency. However, the oncological safety and appropriate indications for these strategies require careful assessment. Despite the low certainty of evidence, conization with negative margins may be offered for FIGO 2018 stage IA1–IA2 disease, irrespective of lymphovascular space invasion (LVSI). Simple trachelectomy may be preferred for stage IB1 disease without LVSI, whereas evidence remains insufficient to choose between simple and radical trachelectomy in LVSI-positive disease. Routine cerclage at the time of trachelectomy is not supported by current evidence. Completion hysterectomy after childbearing provides no established oncological benefit and should not be systematically performed. For stage IB2 disease, neoadjuvant chemotherapy followed by fertility-sparing surgery remains investigational because of uncertain oncological safety and a potential adverse effect on survival. OP appears oncologically acceptable in carefully selected premenopausal patients undergoing surgery, particularly those with early-stage squamous cell carcinoma. OT preserves ovarian function in approximately two-thirds of patients receiving pelvic radiotherapy, especially in women younger than 40 years when both ovaries are positioned above the radiation field. However, OP and OT must be balanced against the risk of ovarian metastasis and should be approached cautiously in patients with adenocarcinoma, advanced disease, or uterine corpus, parametrial, or lymph node involvement.