Occupational lead exposure remains a significant public health concern, particularly due to its detrimental effects on reproductive health in both men and women. Lead, a toxic heavy metal, disrupts multiple physiological pathways, leading to infertility, hormonal imbalances, and adverse pregnancy outcomes. In males, chronic lead exposure is associated with reduced sperm quality, impaired spermatogenesis, and endocrine dysfunction due to its toxic effects on the hypothalamic-pituitary-gonadal (HPG) axis. In females, lead exposure has been linked to menstrual irregularities, spontaneous abortions, and reduced ovarian reserve. Physiological mechanisms involve oxidative stress, DNA damage, endocrine disruption, and impaired calcium metabolism, which collectively contribute to reproductive dysfunction. Clinically, these reproductive impairments translate into increased infertility rates, higher pregnancy complications, and long-term health risks for offspring. Preventive strategies, including stringent occupational safety regulations, regular biomonitoring, chelation therapy, and improved workplace protective measures, are essential to mitigate the risks associated with lead exposure. This review highlights the pathophysiological impact of occupational lead exposure on reproductive health and underscores the need for enhanced occupational health policies to protect workers from its adverse effects.