OBJECTIVE The purpose of this review is to improve the basis upon which advice on pregnancy is given to renal transplant recipients in the reproductive age group. The review attempts to impart up-to-date evidence-based information on the predictable outcome and the risk of pregnancy after kidney transplantation. RESULTS A current change in the consensus opinion of American Society of Transplantation regarding timing of pregnancy after transplantation. There are conflicting data regarding the utility of drug monitoring and dose adjustments of immunosuppressive medications during pregnancy and breast feeding. There is a recent change in the U.S. Food and Drug Administration category of mycophenolate mofetil from pregnancy Class C to D based on recent adverse fetal and neonatal outcome. CONCLUSIONS Counseling regarding pregnancy should be an integral part of caring for the kidney transplant patient in the reproductive age group. Ethical concerns exist about advising pregnancy and fertility treatment for a woman whose life expectancy may be affected by outcome of pregnancy. Toxic effects of newer immunosuppressive medications exposed in utero and during breast feeding and its long-term effects in the offspring have to be clearly defined. The need for longitudinal studies and multicenter observational studies cannot be over emphasized to help answer our considerable gaps in this area.