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Chronic renal failure and renal replacement therapy pose significant challenges to male fertility. This article explores the impact of hemodialysis and peritoneal dialysis on sperm production and quality. Endocrine disturbances, such as changes in reproductive hormone levels, and anatomical abnormalities, such as varicocele, contribute to fertility problems. Renal replacement therapy can exacerbate these problems through exposure to toxic substances and changes in the composition of dialysate fluid.Strategies to preserve and improve fertility include hormonal monitoring, sperm cryopreservation, the use of reproductive assistance techniques, and the adoption of a healthy lifestyle. Awareness of these issues and access to specialized counseling services are crucial to supporting men facing these health challenges. A multidisciplinary approach, involving fertility specialists, is essential to optimize the chances of fertility in these patients.