Fertility-sparing surgery for early-stage cervical cancer aims to preserve reproductive potential without compromising oncologic outcomes. Post-operative surveillance must balance 3 priorities: early detection of treatable recurrence, detection, and management of premalignant disease in the residual cervix or upper vagina, and avoidance of low-yield tests that trigger additional procedures, cancer-related distress, and potentially detrimental effects on fertility. This narrative review summarizes the best available evidence on follow-up after fertility-sparing surgery for human papillomavirus-related cervical cancer, with specific attention to the comparative value of human papillomavirus testing versus symptom review, pelvic examination, colposcopy, and cervical cytology. Key findings include: (1) Many clinically relevant central recurrences occur early, although extra-cervical relapse remains important in higher-risk cohorts, supporting careful clinical follow-up in the first post-operative years; (2) Cervical cytology after trachelectomy frequently yields abnormalities that rarely change management, highlighting the importance of confirmatory colposcopy; and (3) Combining human papillomavirus status and cytology results stratifies risk for subsequent recurrent cervical intra-epithelial neoplasia grade 2 or worse, suggesting a role for risk-adapted surveillance intervals. Currently, evidence does not support indiscriminate routine human papillomavirus testing for all patients after fertility-sparing surgery as a standalone strategy to detect invasive recurrence. However, selective use in combination with cytology and colposcopy, particularly to tailor visit frequency in patients with reassuring results after the first year, is supported by emerging evidence and is consistent with contemporary guidance. Any implementation should define management pathways for positive tests and account for the low pre-test probability of recurrence in many patients, so that harms from false positives do not outweigh benefits.