Pediatric and adolescent gynecologists should be able to discuss the basics of ovarian reserve, gonadal risk, available fertility preservation options, and future implications with girls facing fertility-threatening conditions or treatments, and are often members of formal fertility preservation programs. Baseline ovarian reserve testing, including follicle stimulating hormone with estradiol, antimullerian hormone, and an antral follicle count can be useful for both assessing risk prior to gonadotoxic treatment and assessing ovarian damage following gonadotoxic treatment, although normal ranges specific to pediatric and adolescent girls have not been clearly defined. There are also publicly available online tools to help providers with risk assessment, but it is important to note that these resources do not take into account differences in baseline characteristics, such as ovarian reserve. Additionally, the risk estimates provided by these resources are for ovarian failure, not necessarily impaired fertility or a shortened reproductive window. Options for fertility preservation include gonadotropin-releasing hormone agonists for ovarian suppression, egg or embryo cryopreservation, ovarian tissue cryopreservation, ovarian transposition or shielding, and doing nothing/accepting risk. Where possible, multidisciplinary fertility preservation programs should be established, as having a formal program has been shown to increase both fertility preservation counseling and utilization.