As cancer incidence and survival rates increase among individuals of reproductive age, fertility preservation has become a critical component of comprehensive cancer care. Gonadotoxic treatments –such as chemotherapy, radiation, and surgery –can significantly impair reproductive potential, yet access to fertility preservation remains inconsistent. This review examines the clinical and logistical considerations involved in implementing fertility preservation for cancer patients, including patient selection, preservation methods, timing, and barriers to care. A systematic literature search was conducted using PubMed, ScienceDirect, and Embase from inception to February 2025, including original research, observational, and qualitative studies. Despite guidelines from ASCO and ASRM recommending early fertility preservation consultation, referral rates remain low due to provider, institutional, and financial barriers. The choice and feasibility of fertility preservation depend on factors such as cancer type, treatment urgency, patient age, and overall medical condition. Oocyte and embryo cryopreservation are standard options, while ovarian tissue cryopreservation is suitable for prepubertal patients or those requiring urgent treatment. Fertility preservation requires timely, multidisciplinary coordination, with individualized patient assessment and early referral essential for optimizing outcomes. Addressing systemic, educational, and financial obstacles is crucial to ensuring equitable access and maintaining future parenthood opportunities as a priority in oncologic care planning. (Fertil Steril ® 2025;124:585–92. ©2025 by American Society for Reproductive Medicine.) Key Words: Fertility preservation, cancer, oncofertility, oocyte cryopreservation, embryo cryopreservation