Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease. Fertility-sparing therapy for affected women, especially for those whose lesions are hypervascular of childbearing age is a challenge. The authors therefore decided to investigate the methods of fertility-sparing therapy for patients with PSTT. The cases of three patients with PSTT are presently described. All presented with disease confined to the uterus, and the lesions were hypervascular. Two patients underwent dilatation and curettage, and combined etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin (EMA/CO) chemotherapy. One patient underwent hysteroscopic resection and EMA/CO chemotherapy. All patients underwent ultrasonography postoperatively to reevaluate the size of the lesion. The patients retained their reproductive function with no serious hemorrhage noted. The authors believe that patients with PSTT may be candidates for conservative therapy, even if the lesion is hypervascular. The sonographic presentation is important in deciding the treatment for affected patients.