With improved outcomes after heart transplantation (HTx), there is a growing pool of individuals of childbearing age who may wish to consider pregnancy. Pregnancy after HTx requires anticipatory planning and guidance, careful patient risk assessment with a discussion of individualized risk, close monitoring of graft function and immunosuppression, and vigilance for optimization of comorbid conditions. With a multidisciplinary approach and team, pregnancy after HTx is feasible in selected patients. In the future, multicenter registries may provide much-needed experience to craft future guidelines and recommendations concerning pregnancy after HTx.