Purpose of Review <p>Breast cancer is the most common malignancy among women of reproductive age, with many women affected before or soon after childbearing. Treatments frequently increase the risk of ovarian injury and infertility, making early family-building decisions and timely counseling essential.</p> Recent Findings <p>Extended adjuvant endocrine therapy can further complicate pregnancy planning; however, recent evidence—including results from the POSITIVE trial—demonstrates that temporarily interrupting treatment to pursue childbearing and breastfeeding is safe for appropriately selected patients. In addition to fertility loss, many patients experience sexual dysfunction and diminished quality of life due to prolonged estrogen deprivation. Despite the availability of successful fertility preservation technologies, many survivors report inadequate counseling and limited access, particularly among minorities and underserved populations.</p> Summary <p>This manuscript reviews fertility risk stratification, preservation options—including implications of ovarian tissue freezing—sexual health management, contraception, and survivorship care. Emphasis is placed on early, individualized counseling, equitable access, and multidisciplinary collaboration to optimize reproductive and sexual health in cancer care.</p>