2nd gen? You mean the who 'give birth' thing?
I would love it. Reservation that is, not just the procreation part.
But not with Bethesda. I wnat whoever designed it originally to be in charge of implementing it into a Fallout game.
I don't mind the idea of curing sterility among mutants, but a wondercure should not be there with the snap of fingers.
No, it should require sacrifice, it should require martyrs, it should require time, effort and failures before succession.
If it has a good backstory I am all for curing sterility and having 2nd gen ghouls.
As to the ghoul anatomy it's basically like the human anatomy in the essential places. They have hearts that pump blood which requires oxygen that is absorbed by the lungs which are working by muscles and so on and so forth.
The changes between ghouls and humans is that their bodies constantly rot and regenerate, while a humans cells can only go through 7 stages (I think it was 7) during our lifetime and when the 7th one is in line we're in a dying state the ghoul's cells have a higher amount of stages OR they replace their lost cells with new ones constantly.
I don't know how radiation works with them though and why they're immune.
And they for some reason have low or no body heat.