Purpose of Review <p>This review examines the impact of breast cancer treatments on fertility in young women and explores strategies for fertility preservation. It highlights what is known about the effects of chemotherapy, hormonal therapies, and targeted treatments for breast cancer on ovarian function, emphasizing the importance of integrating fertility preservation into oncology care.</p> Recent Findings <p>Systemic treatments, including chemotherapy and targeted agents like PARP inhibitors and CDK4/6 inhibitors, have the potential to significantly affect ovarian reserve and fertility. As treatment protocols become more prolonged, patients may consider treatment interruption to attempt pregnancy, and studies such as the POSITIVE trial offer new insights into the safety of pregnancy after breast cancer.</p> Summary <p>Personalized fertility preservation strategies are essential for optimizing outcomes in young breast cancer patients. Ongoing research to better understand the effects of treatment on future fertility, as well as mitigation strategies, is necessary to support informed decision-making and improve quality of life.</p>