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This study assessed the needs and perspective of (1) couples and (2) spouses/partners when considering fertility preservation after a cancer diagnosis. Semi-structured interviews explored (1) couples' shared decision-making and (2) spouses'/partners' individual perspectives. Twelve female cancer survivors and their partners (spouses or domestic/romantic partners) (n = 24). Dyadic and individual interviews were conducted using a Decisional Needs Assessment interview guide. Thematic analysis identified key themes. Couples reported making fertility preservation decisions like other major decisions, including prioritizing mutual satisfaction. Partners also reported concerns about patients' health, variable decision-making needs, and letting patients lead. Couples unanimously recommended fertility preservation consultations, and designing resources that provide information and assess needs for both patients and partners. Patients and partners have shared and unique needs when facing fertility preservation decisions. Whenever feasible, psychosocial providers should assess and address couples' and partners' fertility preservation decision-making needs. [ABSTRACT FROM AUTHOR]