Purpose of Review <p>As survival rates among breast cancer patients continue to rise due to treatment advancements, survivorship challenges—including fertility and family-building—have garnered increasing clinical and personal relevance. Many survivors face treatment-induced infertility, prompting discussions of alternative pathways to parenthood and family building such as donor egg in vitro fertilization (IVF), adoption, and surrogacy. The purpose of this review is to investigate family building options for breast cancer survivors.</p> Recent Findings <p>The POSITIVE trial (Partridge et al., 2023) was a prospective, international study evaluating the safety of temporarily interrupting adjuvant endocrine therapy to attempt pregnancy in premenopausal women with hormone receptor–positive early breast cancer [3]. Its findings support the feasibility of planned pregnancy attempts, including those using donor embryos, in appropriately selected breast cancer survivors at the appropriate timeframe in the post treatment period.</p> Summary <p>The options of donor egg, adoption and surrogacy each involves complex medical, ethical, emotional, and financial considerations that must be navigated in collaboration with a multidisciplinary team. This review explores the landscape of alternative family-building options for breast cancer survivors, emphasizing the importance of personalized, informed, and compassionate reproductive care.</p>