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In this manuscript we review the most recent data regarding birth rates and complications in the kidney transplant population. Despite improved fertility, contraceptive counseling is infrequent and contraceptive use engenders many problems not frequently seen in women of childbearing age.Pregnancy outcomes in this population are improving, but these patients are still considered ‘high risk’. With improved fertility after transplantation, contraception should be viewed as essential in those who wish to avoid pregnancy. Many forms of contraception are viable for women with a kidney transplant.Given increased rates of preeclampsia, preterm delivery, low birth weight, and increased risk of cesarean section, a multidisciplinary team must be involved, which will tend to everything from general fetal and maternal monitoring, serial measurement of kidney function, and medication adjustment. For all these reasons, contraceptive counseling is necessary for all women of childbearing age, both pre and posttransplantation. Specific methods of contraception can be individualized to a patient's needs and should be discussed between patient and provider. Future study of both reproduction and contraception use in kidney transplant recipients is sorely needed.