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OBJECTIVE We evaluated the oncological and reproductive outcomes after fertility-sparing surgery (FSS) in patients with a stage I adult ovarian granulosa cell tumor (AGCT). METHODS The medical records of patients aged <50 years with a stage I AGCT who underwent surgery between January 1983 and April 2017 were reviewed. Fertility-sparing surgery was defined as the preservation of the uterus and at least one adnexa. Outcomes were compared between groups who underwent FSS or radical surgery. Patients who had undergone FSS were contacted to gather reproductive outcomes and menstrual histories. RESULTS A total of 113 patients who met the inclusion criteria were included: 61 had FSS while 52 underwent radical surgery. After a median follow-up of 99.2 months (range 20.2-394.3 months), 30 patients had recurrent disease (17 in the FSS group and 13 in the radical surgery group). Multivariate analysis showed no difference in disease-free survival between the groups who underwent FSS or radical surgery (P = 0.550). In patients who underwent FSS, incomplete staging was significantly associated with the risk of recurrence (P = 0.024). Of the 22 patients desiring pregnancy, 19 achieved 20 singleton pregnancies. The pregnancy rate was 86.4% and the live birth rate was 95%. CONCLUSIONS FSS is an acceptable option for young patients who wish to preserve their fertility. Secondary surgical staging is an important treatment in patients with an unstaged AGCT. Reproductive outcomes are promising. Radical surgery might be delayed until recurrence, provided they are willing to undergo a prolonged follow-up.