The Endocannabinoid System (ECS) is highly expressed in male and female reproductive tissues and plays a key role in processes related to conception and pregnancy. Cannabis use during pregnancy is increasing. Conducting meaningful clinical research on this topic is challenging due to cannabis’ Schedule 1 status since 1970 and difficulties in conducting controlled prospective randomized studies of cannabis in the context of pregnancy. Animal models consistently show that cannabis exposure in males is associated with negative effects on testicular volume, sperm morphology, sperm motility, sperm DNA fragmentation, dysregulated sex hormone status, and seminal fluid changes. Emerging data indicate that maternal human cannabis exposure, especially early in pregnancy, is associated with adverse outcomes including low birthweight and small for gestational age, premature deliveries, and increased NICU admissions, and potential long-term neurobehavioral consequences in offspring. There is a substantial gap in reliable information for both the public and HealthCare Providers (HCPs). For many reasons, patients often do not turn to their HCPs for information about the benefits and risks of cannabis use in the context of conception and pregnancy. HCPs are encouraged to become familiar with this topic and to educate and counsel, as appropriate, those considering or at risk for pregnancy.