Infertility risk and fertility preservation (FP) are often salient quality-of-life concerns for young adults (YAs; i.e., 18-39 years old) who have experienced a cancer diagnosis. However, we know little about how members of this population communicate with close loved ones when faced with choices about FP before beginning cancer treatment. In this study, we apply the Family Determinants of Clinical Decisions (DECIDE) Typology to explore how YA cancer patients and their romantic partners negotiate unique and complex decisions about fertility with one another, their parents, and other family members. Through individual semi-structured interviews with 12 YA patient-romantic partner dyads, we found that most (n = 8) YA couples were collaborative in their decision-making communication, but that they varied in the extent to which they valued family involvement (i.e., open-, filtered-, and closed-collaborative). Other YA patients were independent and did not involve any partners or family members in decision-making, or they exemplified incongruent decision-making styles between the involved parties. Our findings have multiple implications for decision-making theory and practice in both cancer and FP communication.