End stage kidney disease (ESKD) has detrimental effects on male sexual hormones, sperm quality and production, and fertility.1 These changes start in early chronic kidney disease2 and are incompletely restored post-transplantation.3 Very little is known about pregnancies fathered by males receiving dialysis,4 with more data available after kidney transplantation.5-10 Recently, attention has been drawn to uncertainties regarding the effects of mycophenolic acid derivatives on male reproduction, with changes to regulatory and pharmaceutical company recommendations, despite reports of good outcomes for children fathered by males receiving this class of drug and no reports of detrimental effect.