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Lynch syndrome and BRCA-mutation associated malignancies are fortunately rare. Affected patients have an increased risk of cancer diagnosis at a young age, often significantly overlapping with their reproductive years. In helping these patients, oncologists must navigate the following areas of care: cancer prevention, impact of cancer prevention strategies on fertility, impact of cancer treatment on fertility, effective cancer therapies, and preservation of fertility without compromising oncologic outcomes. This intersectionality between fertility preservation and effective cancer prevention/therapy makes the care of these patients extremely complex. With the utility of multidisciplinary care models, careful employment of evolving new treatment strategies, it is possible for patients to achieve their fertility desires while at the same time being protected from the risks imposed by their genetic mutations.