This chapter provides insight into the fertility management of cancer survivors with compromised or absent ovarian function and without cryopreserved material. It begins with the evaluation of the cancer survivor for pregnancy. A flow-chart of cancer survivor screening is shown. Standard ovarian stimulation for assisted reproductive technology (ART) results in high levels of circulating estrogen, potentially 10 times the peak levels of spontaneous cycles. The mechanics of oocyte donation involves a number of steps: the recruitment of suitable donors, informed consent of donors and recipients, matching of donors to recipients, ovarian stimulation of the donor and the retrieval of her oocytes. Third-party reproduction is one of the most ethically complex aspects of reproductive health care. The chapter addresses, among other things, issues that occur when preservation of fertility has not been possible or has not been the best choice for a given individual.