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Diagnostic hysteroscopy and targeted resection of a polyp located at the cervicouterine junction revealed uterine adenosarcoma without sarcomatous overgrowth (FIGO stage T1a). Imaging confirmed no residual tumor or metastasis. A fertility-sparing management strategy was chosen, avoiding hysterectomy but involving close oncological surveillance with quarterly MRI scans. During follow-up, a concurrent diagnosis of symptomatic endometriosis introduced therapeutic challenges. The patient spontaneously conceived in 2023 and delivered a healthy infant by cesarean section at term in 2024. Subsequent hysteroscopy and imaging in 2025 showed no evidence of recurrence, therefore fertility-preserving management was continued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Perspective<\/jats:title>\n                    <jats:p>A short narrative of the patient\u2019s perspective on her initial diagnosis, possible fertility loss, and the emotional turmoil of pregnancy after uterine adenosarcoma is presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Treating young patients diagnosed with uterine adenosarcoma poses a challenge to the treating physician due to the lack of guidelines and evidence regarding fertility-preserving treatment of this rare tumor. This report adds to the limited literature on successful pregnancy after uterine adenosarcoma and discusses indications and limitations of fertility-sparing treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fertility preservation may be possible in selected early-stage uterine adenosarcoma cases without high-risk features such as sarcomatous overgrowth or myometrial invasion, with thorough counseling and strict follow-up. Further research is needed to develop standardized protocols and improve management in this context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08443-x","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:47:05Z","timestamp":1782200825000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fertility-sparing strategy in a rare case of uterine adenosarcoma and consecutive spontaneous pregnancy and livebirth"],"prefix":"10.1007","volume":"313","author":[{"given":"E.","family":"Ziegler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Altmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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The authors have no relevant financial or non-financial interests to disclose. Informed consent was obtained from the patient. The participant has consented to the submission of the case report to the journal.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"209"}}