Purpose <p>To assess the impact of employer-provided financial support on graduate medical trainees’ decision to pursue fertility preservation and to identify perceived barriers to participation in fertility preservation.</p> Methods <p>An anonymous online survey study addressing perspectives surrounding participation in elective fertility preservation while in training was distributed in August 2024 to residents and fellows in graduate medical programs across the United States.</p> Results <p>Of 306 medical trainee respondents, 202 (67.1%) had intentionally delayed childbearing due to their medical training. There were 66.4% (<i>n</i> = 200) who reported that their sex/gender impacted their interest in fertility preservation, including 87% (<i>n</i> = 172) of whom had been assigned female at birth. High costs and time constraints of training were the most commonly cited factors (63.1%) negatively impacting the decision to participate in elective fertility preservation. Employer financial support was reported by 32.9% (<i>n</i> = 99) as a factor that would make them more likely to pursue fertility preservation. Trainees who worked an average of 60 to &gt; 80&#xa0;hours per week had the highest rate of reported intentional delay in childbearing, and the time constraints of training negatively impacted their interest in fertility preservation. Only 24% knew whether coverage for fertility services was mandated in their state, 25.2% were unfamiliar with fertility preservation, and 35.3% did not know how to access fertility services.</p> Conclusion <p>Medical trainees face significant financial and structural barriers to accessing fertility preservation. Widespread financial benefits and systemic changes in training programs may improve the feasibility of fertility preservation for graduate medical trainees.</p>