Surveillance for work related adverse reproductive outcomes was discussed. Adverse reproductive outcomes were described. Reproduction disorders that can be associated with maternal or paternal exposures to environmental agents included infertility, early fetal loss, altered sex ratios, late fetal death, low birthweight, birth defects, developmental disorders, childhood cancers, and childhood mortality. It was noted that surveillance can be performed for some reproductive disorders by registering vital events such as fetal deaths and births. If information on parental employment is included on the vital records, endpoints such as altered sex ratio, late fetal death, neonatal death, low birth weight, and some birth defects can be used to assess reproductive outcomes of persons in broad industrial and occupational categories. The further the outcome is removed in time from the time of exposure, however, the more difficult it may be to relate the event to parental exposure. The historical background of surveillance for adverse reproductive outcomes was outlined. NIOSH activities related to reproductive disorder surveillance were discussed. Attempts by NIOSH and others to develop a national surveillance system for reproductive disorders have been unsuccessful. NIOSH has developed a program that encourages the states to develop the capacity to code industry and occupation information on death certificates as part of a national strategy for monitoring adverse reproduction outcomes. The roles of the states, hospitals, and industry in monitoring work related reproduction disorders were discussed. The authors recommend using the NIOSH national strategy to guide and focus efforts, to improve communication among public health and occupational constituencies, and to encourage the development of new, creative surveillance systems.