The mortality rate from breast cancer has decreased over the last two or three decades and issues of survivorship have become increasingly important. Approximately 1 in 200 women under the age of 40 develop breast cancer, and with the increasing age at first and subsequent pregnancies in the UK and Europe the issue of fertility for young women who may not have started their families may be a major consideration. The increasing use of adjuvant chemotherapy in breast cancer means that many women diagnosed with breast cancer will undergo temporary or permanent chemotherapy-induced amenorrhoea. This may be associated with physical, psychological and psychosocial implications, with women experiencing the acute toxicities associated with menopause as well as long-term health risks including loss of bone mineral density and possibly some increased cardiovascular risk. Following chemotherapy very few women become pregnant, and this may partly be due to concerns about the risks of pregnancy, both to themselves and in relation to their potential future offspring. Modern techniques used to preserve fertility in the general population may be applicable to some women with breast cancer. The use of such techniques needs to be considered on an individual basis for each woman in light of the recommended systemic adjuvant treatment, the woman's age and her own risk of recurrence with and without systemic treatment. Further clinical research is necessary to substantiate the safety of these approaches to fertility in women who have been diagnosed with breast cancer.