Partners play a critical role in making decisions about fertility preservation among young patients with cancer, yet little is known about these dyadic decisions when planning cancer treatment. Fertility preservation entails helping cancer patients preserve fertility after cancer treatment. This qualitative study investigated: 1) Heterosexual couples' responses to potential fertility loss; 2) their process in making fertility preservation decisions; 3) their ethical and legal concerns, and 4) recommendations for other couples undergoing similar treatment. Semi-structured interviews were conducted with 12 heterosexual couples whose female partners were diagnosed with cancer and had received fertility preservation consultations within the past 5 years. Interviews were recorded, transcribed, and analyzed using grounded theory methods. The results indicated that couples have varied reactions to infertility. In most, spouses let the patients take the lead in, and supported, their fertility preservation decisions. Spouses recommended support to patients. Couples face challenges in making fertility preservation decisions. Input from, and support for, both partners is essential to ensure well-informed, high-quality fertility preservation decisions.