Objective To explore the factors influencing fertility preservation decision-making among female cancer patients, and to provide reference for the construction and improvement of a fertility decision support system for female cancer patients.Methods A systematic search was conducted in the PubMed, Embase,Web of Science, Scopus, CINRHL, CNKI, Wanfang Data, VIP and SinoMed to identify relevant studies.The included studies were evaluated and analyzed according to the mixed methods systematic reviews guidelines.The search period was from database establishment to March 15, 2025.Results A total of 30 studies were inclu-ded, with 15 quantitative studies, 11 qualitative studies, and 4 mixed methods studies.Thirty-one factors influencing fertility pre-servation decision-making among female cancer patients were extracted and categorized into five categories:sociodemographic factors, disease treatment factors, psychological cognitive factors, social support factors, and organizational policy factors.Conclusion Fertility preservation decision-making among female cancer patients is influenced by various factors.Medical staff should pay attention to fertility preservation decision-making among female cancer patients, improve oncofertility support systems, and reduce patient decision-making conflicts.