Advancements in solid organ transplantation have significantly improved patient survival and quality of life, making parenthood an achievable goal for many recipients. However, fertility restoration after transplantation presents unique challenges. In women, endocrine function and ovulatory cycles often resume quickly following kidney or liver transplants, but pregnancy outcomes are associated with higher risks, including preeclampsia, preterm birth, and low birth weight. In men, transplantation can improve hypogonadism and sperm abnormalities linked to pre-transplant conditions, although some immunosuppressive drugs, such as mTOR inhibitors or cyclophosphamide, may impair fertility. Available evidence suggests that with proper management, parenthood after transplant is safe and successful, and the risk of congenital malformations in offspring from male transplant recipients is comparable to the general population. Furthermore, assisted reproductive technologies (ART), including IVF, have been shown to be effective in this population, though careful protocols to prevent complications like ovarian hyperstimulation syndrome (OHSS) are crucial. Emphasis on preconception counseling, family planning, and multidisciplinary care is key to minimizing risks and ensuring the health of the mother, child, and transplant. This review presents recent evidence and practical strategies to optimize fertility outcomes in transplant recipients.