Growth hormone (GH) deficiency is associated with decreased fertility. Since the placenta starts to produce a biologically active GH variant in the first gestational weeks, GH replacement therapy is usually stopped upon confirmation of conception or in the first trimester. Also acromegaly is associated with decreased fertility caused either by size effects of the pituitary adenoma that might lead to gonadotroph insufficiency or co-secretion of prolactin. Women with acromegaly should be treated in centers with adequate experience. In women with macroadenomas, transsphenoidal removal or size reduction of the adenoma prior to conception should be considered. The size of GH producing adenomas or residual tumors usually does not increase during pregnancy and symptoms of acromegaly might even improve due to hepatic GH resistance caused by high estrogen concentrations. In case of symptomatic tumor growth during pregnancy pharmacologic therapy with the somatostatin analogs octreotide and lanreotide might be considered before surgery. Comorbidities of acromegaly such as impaired glucose tolerance, diabetes, and hypertension deserve special attention. Rebound disease activity after delivery is frequent.