Fertility in men with isolated epispadias is often lower than fertiity in the normal population. Abnormal ejaculation, a lower sperm count, or azoospermia is seen in roughly half to three quarters of men with exstrophy-epispadias complex. Theoretically, if normal sperm are present in the testicles of these men, the potential for fatherhood exists, but assisted fertility techniques may be required to overcome poor sperm quality.

Women with epispadias who are pregnant may have more difficulty carrying their baby to term than other women because of differences in their pelvises and other organs. Gynecologist/obstetricians may decide to monitor pregnant women with epispadias more often and more carefully.