An ongoing increase in survival rates among young leukemia patients is accompanied by a growing attention to possible long-term complications such as chemotherapy induced ovarian insufficiency and infertility. Therefore, an important element of the management of these patients is fertility preservation, which is challenged by considerations specific for leukemia. Such considerations include prepuberty, poor medical condition on presentation and the need for urgent chemotherapy, all of which may preclude the use of conventional assisted reproductive technologies. A restrictive approach towards utilizing cryopreserved ovarian tissue due to the risk for malignancy reintroduction on transplantation, further minimize the options that currently exist for these patients. This paper aims to provide up-to-date knowledge on gonadotoxicity associated with therapy regimens currently used in the treatment of leukemia. Different fertility preservation techniques are discussed, with an emphasis on efficacy, applicability and limitations in the context of leukemia.