Fertility preservation has become an essential component of comprehensive cancer care for young women, reflecting a growing recognition that survival must be accompanied by quality of life and the possibility of future parenthood. While fertility-sparing strategies are well established for certain common gynaecological cancers, their application in rare and uncommon malignancies remains complex. These tumours include rare histological subtypes of ovarian, cervical, uterine, vaginal and vulval cancers. They are often characterised by aggressive biology, diagnostic uncertainty and a limited evidence base, which creates unique challenges in balancing oncological safety with reproductive potential. This chapter provides an in-depth review of current fertility preservation approaches in this context, including conservative surgical techniques, ovarian tissue cryopreservation, ovarian transposition, embryo and oocyte cryopreservation, in vitro maturation, and selected medical strategies. Tumour-specific considerations for germ cell tumours, sex-cord stromal tumours, uterine sarcomas, neuroendocrine carcinomas, and paediatric and adolescent presentations are discussed. Emerging and experimental avenues such as artificial ovaries, uterus transplantation, and in vitro gametogenesis are examined for their potential to expand reproductive options in the future. Central to effective care is a multidisciplinary, individualised approach that incorporates gynaecologic oncology, reproductive medicine, pathology, radiology, nursing, and psychological support, underpinned by clear communication and informed consent. Embedding fertility considerations early in the cancer care pathway enables clinicians to align oncological management with patients’ reproductive goals, ensuring a more holistic approach to treatment.