Primary care providers play an important role in providing gynecologic and reproductive health counseling. Many solid organ transplant (SOT) recipients are of reproductive age and are interested in conceiving and carrying a child. Solid organ transplantation often facilitates return to fertility for patients who previously experienced infertility due to end-organ disease. There is a high rate of unplanned pregnancies among SOT recipients which can amplify the already increased pregnancy-related health risks for the recipient, fetus, and graft. To optimize pregnancy outcomes, primary care providers should discuss the importance of contraception, pre-conception care, medication management, and pregnancy timing with SOT recipients as part of a larger discussion with the multidisciplinary healthcare team including maternal–fetal medicine providers, transplant specialists, and pharmacists.