Despite the father transmitting half the heritable information to the embryo the focus on preconception health has largely been on the mother. New studies highlight the role of the father in disease transmission via non-genetic inheritance, through epigenetic mechanisms. Epigenetic mechanisms include, DNA methylation, post-translational modifications of histones and noncoding RNAs. Paternal effects have been linked to developmental abnormalities and complex diseases such as cancer, diabetes and obesity. Studies in humans and animals have linked epigenetic inheritance to the transmission of environmentally induced phenotypic traits from the father to the developing embryo and these have been associated with altered gene expression and developmental abnormalities in first and second offspring generations. Our most recent studies of sperm chromatin indicate that environmental challenges can alter the sperm epigenome in a cumulative manner to negatively impact embryo development. In translational studies we have determined that a man’s BMI, can alter the sperm epigenome at regions that are implicated in fertility and embryo development. Moreover, in a South African population of men exposure to DDT is associated with alterations to the sperm chromatin, occurs at genomic regions that persist in the pre-implantation embryos at genes that are implicated development including neurodevelopment. These findings indicate that paternal exposures may influence fertility and child health. Additionally, they underscore the need to amplify in depth pre-conception advice for youth and men.