Advances in the treatment and management of thalassemia have led to improved survival of patients, allowing most to reach adulthood, with a life expectancy approaching that of healthy individuals. With this improved survival, many patients started expecting to have a family. For this purpose, the fertility problem among this population has become a very important issue to solve. Although many patients can have spontaneous pregnancies, a good follow-up and sometimes ART treatment might be needed to ensure pregnancy in others. Pregnancy, however, remains challenging, with many complications that can affect the pregnancy and the mother. With a hypercoagulable state during pregnancy, increased stress on the heart, and physiologic anemia, managing pregnancy among thalassemia patients becomes challenging.