Background: Infertility is a major consequence of cancer treatment. The NCCN Guidelines for adolescent and young adult and ASCO clinical practice guidelines recommend that the cancer patient of reproductive age should be informed on the possibility of treatment-associated infertility and methods available for fertility preservation prior to treatment initiation. The discussion should be documented in the medical record system. Despite the emphasis on guidelines, fertility preservation is one of the least implemented services in oncology. As a quality improvement initiative, we examined the documentation rate of fertility preservation discussion in young adults with cancer. Methods: The patients between the ages of 18 and 45 years seen in the oncology clinic from January 1, 2018 to August 31, 2019 as a new patient or who underwent hematopoietic stem cell transplant during this period were included in the study. The data regarding the documentation of fertility preservation discussion as well as the demographics of the patients were collected. We also performed an electronic survey among the oncology providers regarding their knowledge and practice on fertility preservation. Results: A total of 521 cases were reviewed with 218 patients (median age, 37 years; 55.9 % female; 72% between age 18-40) meeting the inclusion criteria. Among these patients, only 16% of the patient (n=36) had documented treatment-related infertility counseling. The documentation was highest among patients with breast cancer (n=17) followed by testicular cancer (n=5). There was no statistically significant difference in fertility counseling by gender or cancer type (hematological vs solid). In the electronic survey done among 20 oncology providers, a majority of the clinicians responded that they discussed and documented fertility preservation counseling less than half of the time. Some of the main reasons for not discussing were reported to be the urgency of starting chemotherapy, cost, lack of information, and insufficient time in the clinic. Conclusions: Although it is recommended to discuss the possibility of infertility and options available for fertility preservation prior to initiation of treatment in young adults with cancer; fertility preservation is one of the least implemented services in oncology. Moving forward, conducting quality improvement projects will be instrumental to characterize and improve the compliance on fertility preservation counseling and documentation.