Impact of an oncofertility program on fertility discussions, referrals, and use of fertility preservation options. Pre-program 2004–2006 cohort, n =278. Post-program 2007–2012 cohort, n =515. Discussions about treatment-related infertility increased from 9% to 38%, (P <0.001). Documented interest in maintaining fertility at diagnosis increased from 13.3% to 21.7% (P <0.0041). Referrals to reproductive specialists (4% vs. 28%, P <0.001), appointments (5% vs. 18%, P <0.001), and procedures (4% vs. 8%, P <0.0183) all increased in the post-program cohorts.