Women with epilepsy are less likely to have children than women without epilepsy. For many years, it was assumed this was because women with epilepsy were less likely to be married and, when married, more likely to choose to remain childless. Women with epilepsy now have marriage rates equivalent to women without epilepsy. Better prenatal care and information about the excellent outcome for more than 90% of pregnancies in women with epilepsy suggest that more women are able to choose to be mothers. However, birth rates remain lower than expected. In part, this can be explained by recent findings that women with epilepsy are less likely to ovulate and more likely to have disorders of reproductive hormones. Whether these reproductive health disturbances are caused by seizures, by antiepileptic medications, or by both, is now being debated in the medical community. This chapter discusses some of the reproductive disturbances in women with epilepsy and points out signs and symptoms that women should report to their health-care providers.