Objective To assess which characteristics are associated with failure to receive fertility counseling among a cohort of young women diagnosed with cancer. Design Population-based cohort study. Setting Not applicable. Patient(s) A total of 1,282 cancer survivors, of whom 1,116 met the inclusion criteria for the analysis. Intervention(s) None. Main Outcome Measure(s) The main outcome in this study was whether or not women reported receiving any information at the time of their cancer diagnosis on how cancer treatment might affect their ability to become pregnant. Result(s) Forty percent of cancer survivors reported that they did not receive fertility counseling at the time of cancer diagnosis. Women were more likely to fail to receive counseling if they had only a high school education or less or if they had given birth. Cancer-related variables that were associated with a lack of counseling included not receiving chemotherapy as part of treatment and diagnosis with certain cancer types. Conclusion(s) Counseling about the risk of infertility and available fertility preservation options is important to cancer patients. Additionally, counseling can make women aware of other adverse reproductive outcomes, such as early menopause and its associated symptoms. Less-educated women and parous women are at particular risk of not getting fertility-related information. Programs that focus on training not just the oncologist, but also other health care providers involved with cancer care, to provide fertility counseling may help to expand access.