Purpose of Review <p>Review the current literature regarding fertility preservation options for patients with breast cancer receiving gonadotoxic chemotherapy and common barriers to treatment.</p> Recent Findings <p>Oocyte and embryo cryopreservation are considered the gold standard modalities for fertility preservation. Ovarian tissue preservation is no longer considered an experimental treatment option by ASRM, but patient access to this modality is limited. GnRH agonists may reduce the risk of primary ovarian insufficiency and improve pregnancy rates after completion of cancer therapy, but data on its efficacy in fertility preservation is mixed, and there is limited data on long term outcomes.</p> Summary <p>Counseling regarding the potential impacts of cancer treatment on fertility soon after diagnosis and regardless of cancer staging or patient age reduces patient distress. Early referral to a Reproductive Endocrinology and Infertility (REI) specialist soon after diagnosis can streamline access to fertility preservation methods. Insurance coverage impacts access to fertility treatment and differs by state in the U.S.</p>