The increased survival rates for pediatric cancer patients and for some malignancies that are common in young adults, such as testicular cancer and Hodgkin disease have led to an increased focus on preserving fertility. Research on the psychosocial aspects of cancer-related infertility is a recent development, but we know that both young men and women value parenthood after cancer. At least 75% of survivors who were childless at diagnosis would like future offspring. For those who do not become parents, long-term distress is common. Younger teens may have difficulty assessing whether parenthood will be important to them in the future, and informed consent protocols need to respect their desires rather than deferring too much to parents. We do not know whether parenting a non-biological child (adopted, conceived through third-party reproduction, or a stepchild) reduces distress as much as being able to have one's own genetic offspring. Survivors often have exaggerated concerns about their children's health risks, but still prefer to have biological children if possible. More research is needed on whether participating in fertility preservation reduces long-term distress about cancer-related fertility. Better evidence-based programs to educate families and reduce decisional conflict are needed. Pediatr Blood Cancer 2009;53:281–284. © 2009 Wiley-Liss, Inc.