BACKGROUND: Cancer treatment can significantly reduce reproductive potential in female patients. This study sought to explore the incidence of fertility counseling in women of childbearing potential before, during, and after anticancer therapies. METHODS: We conducted a retrospective medical record review at a major Australian cancer center of premenopausal females aged 18 to 49 years diagnosed with cancer between 2017 and 2020. RESULTS: A total of 143 patients met inclusion criteria. Of these patients, only 12.6% had a reproductive health history documented at the first consult and just more than half (58%) had a fertility preservation discussion documented with their primary hematologist or oncologist. A quarter (25.9%) saw a specialist gynecologist to discuss fertility preservation options, and 11.2% were offered a referral but declined. CONCLUSIONS: In an Australian major cancer center, only half of women with a new malignancy diagnosis had documented reproductive counseling. Promoting and facilitating reproductive counseling needs to be addressed through strengthening working relationships between fertility preservation specialists and oncologists/hematologists, implementing technology systems to ensure fertility preservation documentation, and improving staff education.