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Fertility preservation is a critical component of supportive, patient-centered oncology care, especially when gonadotoxic therapy is planned. The optimal strategy for women is referral to a reproductive endocrinologist for timely counseling and consideration of oocyte or embryo cryopreservation before chemotherapy. These methods have the strongest evidence for future live birth potential. GnRH agonists may reduce chemotherapy-induced ovarian insufficiency in some settings but are not a substitute for cryopreservation and should be considered adjunctive. Deferring conversation until after treatment (Option A) often results in irreversible loss of fertility options. Presenting adoption as the only option (Option D) fails to honor patient autonomy and current reproductive technologies. The APRN coordinates expedited referral pathways, discusses expected treatment timelines, contraception during therapy, teratogenicity, and the psychosocial dimensions of fertility decisions. Documentation of counseling, insurance navigation, and linkage to financial resources or fertility preservation programs are essential parts of comprehensive care.