It is generally agreed that sperm banking should be routinely offered prior to the administration of any anti-neoplastic treatment to post-pubertal males following a diagnosis of cancer. It may also be required following a number of other diagnoses (e.g. some renal or rheumatoid conditions) as well as prior to some pelvic surgery or in cases of gender dysphoria. However, since there are over 5,000 new diagnoses of cancer in the United Kingdom each year in males of reproductive age (up to the age of about 44 years old), the majority of men banking their sperm will be following referral from an oncologist. This has led to the development of specific oncofertility pathways for men (and women) who need to preserve their fertility and these represent a number of significant challenges for health professionals in sperm banks and assisted conception units if a timely and effective service is to be provided. This chapter will review the latest thinking on how to provide an effective and efficient service, as well as consider the management of sperm banks in the longer term.