Background <p>Sickle cell disease (SCD) is a hereditary red blood cell disorder with multi-systemic manifestations, including chronic pain, anaemia, stroke, renal complications, and increased mortality. While these clinical features have been well documented, reproductive health complications among individuals with SCD remain comparatively underexplored.</p> Main body <p>The recurrent vaso-occlusive crises, resulting from microvascular obstruction, can lead to infarctions in the testes and ovaries, thereby impairing spermatogenesis and ovarian reserve. Other associated complications such as priapism and gonadal failure further compromise fertility. Furthermore, whereas chronic transfusion therapy is required in many patients, it predisposes to iron overload-induced gonadal dysfunction. Hydroxyurea has been implicated as a potential gonadotoxic and teratogenic agent. This narrative review presents current evidence on the impact of SCD on reproductive function in both males and females. Emerging strategies aimed at preserving reproductive potential and improving patient outcomes, including preconception counselling, oocyte and embryo cryopreservation, in vitro fertilisation (IVF), and preimplantation genetic testing are highlighted.</p> Conclusion <p>A deeper understanding of how SCD affects fertility, pregnancy, sexual health, and reproductive options is essential to patient-centered care and integrating systems thinking into a multi-disciplinary team approach to improve the overall reproductive health of SCD individuals.</p>