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To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population.Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous studies have evaluated the final measure of male fertility, which is the number of children fathered by patients.Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5 comprehensive Danish linked registers. Patients were matched with 97,805 controls, and the number of fathered children was recorded as the primary outcome.Patients who were operated unilaterally fathered more children than controls (156 vs 147 children per 1000 individuals, P = 0.02), whereas patients who were operated bilaterally fathered the same number of children as controls. Unilateral Lichtenstein operation resulted in an increase in number of children fathered by patients (161 vs 151 children per 1000 patients, P = 0.009). No difference in the number of children fathered was found for any year following operation. Meanwhile, time between operation and first child was longer among controls than patients (log-rank P = 0.003). The youngest (18–30 years of age) bilaterally operated patients fathered the same number of children as controls.Patients who underwent inguinal hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility.