On Dec. 7, 2023, the first night of the Jewish festival of Hanukkah, 51-year-old Sharon Eisenkot heard the knock on the door that every Israeli parent with a child serving in the military dreads. Soldiers had come to inform her that her 19-year-old son, Maor, had been killed in combat in Gaza. The army offered her the opportunity to have her son’s sperm retrieved and frozen, using a process known as postmortem sperm retrieval (PMSR). Eisenkot, a mother of three, gave her permission.
During the Gaza conflict, Israeli medical centers were on call 24 hours a day to perform PMSR. There are four main fertility clinics tasked with keeping up with the demand and the constraints of the 72-hour window for collecting viable sperm postmortem. While the process and storage are state-funded, a local family court must grant permission to implant any PMRS for conception.
Last July, a family court in Eisenkot’s home city of Eilat ruled that she could have a grandchild via a surrogate, a woman Eisenkot chose, who agreed to co-parent the child with her. The case set an important precedent. While several partners of deceased soldiers had successfully obtained court approval for PMSR, Eisenkot’s case was the first time a parent had been granted the right. “Not everyone [every parent] approaches the family court, but whoever will approach in the future, it will be easier,” Eisenkot said. She said she wanted to fulfill her son’s wish to have children, “and mostly to fill my heart and to have some happiness.” The case, and others like it, are part of a rapidly developing legal framework for a situation becoming all too familiar in many wars.
Reproductive technologies, and the ambitions embedded within them, are increasingly playing a role in global conflicts. Fertility tech has now come to be seen as a means of state survival and a new frontier for ethical questions provoked by war.
Conflict can affect medicalized fertility in different ways. Sometimes fertility facilities are directly targeted by military forces, while sometimes medical systems that are crumbling after years of war can no longer keep fertility facilities functioning. In Sudan, access to reproductive technology was limited even before the ongoing war; now it is nonexistent. In Iran, U.S.-led sanctions have indirectly hit the country’s well-established assisted reproductive technology industry, delaying access to specialized medical equipment and supplies, and in some cases hampering it altogether. But it is in Israel and Ukraine that this technology’s effects are most evident.
Israel has been widely criticized for destroying the Al Basma IVF Center, Gaza’s largest fertility clinic, in 2023, during the Gaza war. Around 4,000 embryos were stored at Al Basma, as well as other reproductive material such as frozen sperm and eggs, all harvested from Palestinian patients who were trying to conceive. The United Nations’ Independent International Commission of Inquiry published a report last fall concluding that genocide was occurring in Gaza — and that the IVF clinic bombing represented a genocidal act. Israel rejected the commission’s findings.
The Israeli state has espoused pronatalism since its inception, with early policies supporting a high birth rate. Maternity benefits for working mothers were the first state benefits Israel paid. Israel provides very generous state funding for fertility treatments. The first case of an Israeli child born through IVF was in 1982, only the fifth such conception globally at that time.
The practice of PMSR was already legally and culturally recognized within Israeli society decades before the dramatic increase of the last few years. The case of Israeli soldier Keivan Cohen, killed in 2002 by a Palestinian sniper in Gaza, set a precedent. In 2007, after an extensive legal battle, a Tel Aviv court ruled that Cohen’s parents and a mother of their choosing could use his sperm, which was retrieved postmortem, to conceive. Crucially, the Ministry of Interior was also required to register any children resulting from such inseminations as children of their deceased fathers.
While Israel has a more established history of PMSR, Ukraine’s is specifically connected to the current war with Russia. Ukraine’s first IVF-conceived baby arrived almost a decade later than Israel’s in 1991. Some state funding for IVF was introduced by Ukraine in 2004, but it was limited, and the country’s fertility technology was largely targeted at international users before the war. When Russia embarked on its full-scale invasion in February 2022, Ukraine was known as a hub for fertility tech tourism, with foreigners coming for IVF treatments and to pair up with surrogates, often for a lower price than they would have paid in their home countries. In the last three years, however, the country’s reproductive tech has transitioned to focus on Ukrainian citizens.
The war with Russia is sharpening Ukrainian pronatalism and prompting conversations around fertility issues that had previously been taboo. Before the conflict, there was no legal framework governing PMSR. In 2023, however, the government passed initial legislation outlining state-funded gamete freezing, stipulating that sperm could be collected free of charge from soldiers. Then, in 2024, Ukraine made assisted reproductive technology (ART) available at no cost to citizens under the Medical Guarantee Programme at health care facilities contracted by the National Health Service of Ukraine. And the state amended its initial legislation so that frozen gametes can be kept and used up to three years after death. But only the partner of the deceased — not the parents — is able to use the stored material for conception. PMSR itself remains illegal. And artificial insemination costs are not covered by the state. Both countries are keenly concerned about future demographics, but Ukrainian society lags behind Israel in cultural acceptance of reproductive technology, although the war is breaking down social inhibitions.
Dr. Vitaliy Radko, a specialist in reproductive medicine at the Mother and Child fertility clinic in Kyiv, said he and the staff were under tremendous stress due to the ongoing Russian military aggression. “We have had regular air attacks. We have special generators, but there were days when we were still working without electricity, without water.” He said overwhelming numbers of the women he sees in his practice are under extreme stress and taking antidepressants. As the war enters its fourth year, time spent in bomb shelters, weeks without power and heating, and constant worry about loved ones on the front lines are taking a toll on everyone’s mental health.
Ukraine was experiencing a demographic crisis before 2022 due to high levels of emigration dating back to the 1990s, which the full-scale Russian invasion accelerated. Tens of thousands of Ukrainians have been killed and hundreds of thousands injured on the front lines, while millions seek refuge outside the country.
In the summer of 2025, the government approved a draft law outlining the state’s broader ambitions around ART, with a focus on increasing birth rates by making it easily available and free of charge, although individuals older than 49 who want access to IVF technology will face more in-depth medical scrutiny. Under the law, those with criminal records will be ineligible for treatments.
Meanwhile, as of 2022, Russia has also provided free sperm retrieval and storage for its soldiers. Both sides of this war seem to view soldiers’ reproductive material as a means of perpetuating the state. Ukrainians believe Russia is trying to erase them as a nation. In 2023, amid Ukrainian discussions of ART, Olga V. Skabeeva, a Russian state TV news presenter who is widely described as a Putin propagandist, reportedly claimed during a broadcast that freezing Ukrainian soldiers’ sperm amounted to “genetic experiments to construct a nation.”
In Russia, PMSR exists in a legal gray zone. Sperm can be retrieved and frozen up to 80 hours after death, but the window of viability is generally considered to be up to between 24 and 36 hours. And frozen sperm, eggs and embryos must be stored at around -196 degrees Celsius in liquid nitrogen for preservation. Because the technology for retrieving and freezing eggs has lagged behind that used to store sperm, postmortem egg retrieval remains a niche field and practice. This, coupled with the fact that currently male combatants are dying in wars at a higher rate than female combatants, means the focus has remained on PMSR.
PMSR is banned in numerous countries such as France, Morocco, Sweden, Germany, Slovenia, Denmark and Hungary. In other states — such as Belgium and the U.S. — there is no legislation and the practice is becoming increasingly normalized.
The 1997 legal case of Diane Blood in the U.K. set global precedents in the field. Blood fought to use sperm from her deceased husband, Stephen Blood. Since he had left no written instructions for his gametes after death, Diane took the case to court. She went on to have two children with Stephen’s genetic material, marking the first case of a birth from PMSR. The U.K. subsequently changed the law to ensure that written consent is needed for the use of a deceased person’s gametes or embryos. Explicit written consent, and often other specific requirements, is also necessary to use postmortem retrieved sperm in Canada, Portugal, Spain, Greece, Estonia, South Africa, Japan, the Netherlands, the Czech Republic and several Australian states.
In many ways, Irit Shahar’s legal journey has mapped the path of shifting jurisprudence and public opinion in her home of Israel. Shahar and husband Asher have been fighting the state since 2012 for the right to have a grandchild using their deceased son’s posthumously retrieved sperm. Their son Omri, a captain in the Israeli navy, was 25 when he was killed in a car crash. The couple initially pursued the right to use an egg donor and surrogate to produce a grandchild they would raise themselves, but after a lengthy legal battle they have changed their approach and are now seeking permission to have their son’s gametes used by a woman wishing to gestate and raise a child herself.
“I was the beginning,” Irit said. “Nobody talked about it. When my son was killed, nobody told me that it can be done.” It was only by chance that Irit remembered reading about PMSR and asked if Omri could be a candidate.
The Shahar family’s case touched off a debate — now widespread — on the ethics of PMSR both within Israel and abroad. People questioned the morality of creating a child whose parent was dead. “The dominant ethical considerations tend to turn on consent,” said Dominic Wilkinson, a professor of medical ethics at the University of Oxford. “It’s much more an open question whether everybody would want their gametes to be used after they’ve died to create a child who they’ll never see.”
In the aftermath of the Gaza war, the Israeli military opted to offer PMSR to every deceased soldier’s next of kin, thus removing the need to ask a court’s approval when time was essential. But those partners or parents must still obtain permission from local family courts to use the frozen genetic material for conception. A key question deciding these cases is whether families can prove the deceased soldiers wanted children. In the Eisenkot case, Maor’s friend was able to testify that Maor had told him he wanted children and planned to freeze his sperm.
Prior to 2023, there were 15 to 20 cases of PMSR annually in Israel. The Israeli Health Ministry reports that PMSR has been performed on around 250 soldiers and security personnel since the start of the conflict, with the overwhelming majority of those requests coming from parents of the deceased. Unlike in Ukraine, in Israel both the partner and the parents can request PMSR, with a partner’s wishes superseding those of the parents in cases of disagreement.
Dr. Eran Altman, head of the Rabin Medical Center sperm bank and fertility clinic, said that fertility medicine had changed since Oct. 7, “not because of new data or new techniques, but because of the situation.” Demand had increased since the war began. Currently, Altman explained, there is an Israeli hospital on call for PMSR. But how many of those who choose PMSR actually use the sperm to conceive? “Time will tell,” Altman said.
Even within Israeli society, views on this matter are muddled. Israeli law offers no clear language on using gametes retrieved after death to produce offspring, so individual cases are left to the family courts. A draft law meant to clarify legal rights around the issue was rejected by Prime Minister Benjamin Netanyahu’s coalition government.
In 2025, Professor Bella Savitsky, an epidemiologist and specialist in public health at Ashkelon Academic College, published a study that surveyed the views of 600 Jewish Israeli men on PMSR. The overwhelming majority (71%) preferred to make their preferences known in advance concerning posthumous sperm removal. And 37% opposed the procedure being done at their partner’s request, while 47% objected to it being performed at their parents’ request.
And then there is the reality that such technologies will always take a back seat to the more immediate health care needs of war. “Those who are in a war zone — [the] front line of Ukraine, those who are in Gaza — they have massive health needs,” Wilkinson said. “In a scale of bad and troubling things for those in a war zone, the right to life and the right to basic freedom that is being threatened is probably gonna be a much higher priority than their reproductive rights.”
But many working within reproductive medicine in these spaces feel connected to the survival of the state and the creation and preservation of life. “We are together in this bad situation, and this is the way I can help,” Altman said. “There is some patriotism in that, but humanism too.”
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