Due to significant advances in treatment, the vast majority of children and adolescents diagnosed with cancer now survive into adulthood. Toxicity to the ovaries and testicles is a recognized adverse event of chemo- and radiotherapy and can lead to infertility, thus substantially impacting a patient's quality of life. Currently available options for fertility preservation in children and adolescents undergoing anticancer treatment are mostly experimental, and their use is subject to appropriate regulatory and ethical scrutiny. Experimental procedures, such as cryopreservation of ovarian or testicular tissue, in vitro maturation of gametes, or autotransplantation of gonadal tissue, should only be performed in specialized centers, and institutional review board-approved protocols with stringent consent requirements are highly encouraged. The potential ethical issues associated with fertility-preserving strategies should be fully disclosed to patients and their families, and longterm surveillance of cancer survivors and their offspring should be undertaken.