Background <p>The increasing prevalence of cancer survivors has made fertility preservation (FP) a key concern. Oncologists play a pivotal role in initiating FP discussions, safeguarding patients' potential for future fatherhood, and ultimately contributing to their long-term quality of life. Although understanding methods of fertility preservation is essential, the literature on this topic is scarce within the Saudi population. Therefore, this study assessed oncologists' understanding, attitudes, practices, and barriers toward fertility preservation for cancer patients.</p> Methods <p>A nationwide cross-sectional study was conducted among oncologists from various subspecialties in Saudi Arabia using an online self-administered questionnaire. The questionnaire comprised sociodemographic data, knowledge, current practices, barriers, attitudes, and perceptions to fertility preservation.</p> Results <p>A total of 76 oncologists participated in this study. Only 40.8% had received fertility preservation training, and 85.5% expressed a need for additional training. At the same time, 38.2% reported the availability of preservation services at their institutions; access to FP services varied by geographic location. Although 57.9% of oncologists regularly discussed fertility preservation with patients, only 18.4% consistently referred them to fertility specialists. Moreover, significant knowledge gaps, particularly regarding testicular tissue cryopreservation, were reported. Lastly, barriers to fertility preservation included limited access to services, insufficient knowledge, concerns about oncology treatment delays, and the lack of structured referral systems.</p> Conclusions <p>This study reveals significant gaps in oncologists’ knowledge, training, and practices regarding fertility preservation, particularly sperm cryopreservation. Targeted training and multidisciplinary collaboration are essential to enhance the accessibility of fertility preservation and ensure its proper integration into oncology care.</p>