Israeli men's attitudes toward posthumous reproduction and prior consent amid ongoing armed conflict.

Background: From October 7, 2023, until August 28, 2024, 187 posthumous sperm retrieval (PSR) procedures have been conducted on deceased men, 171 of whom are soldiers. PSR was predominantly initiated by parents to cope with their profound loss. However, the attitudes of Israeli men toward this procedure are unknown.

Objective: This study aims to investigate the attitudes of Israeli men toward prior consent to PSR and posthumous-assisted reproduction (PAR) initiated by partner or parents.

Methods: A cross-sectional study of 600 Israeli men aged 18-49 years who were questioned in February-April 2024 amid the ongoing armed conflict. The questionnaire included demographic details, role in the conflict, and attitudes toward PSR/PAR. Multivariable logistic regression analysis was used to assess agreement for PSR/PAR after adjustment for possible confounders.

Results: The average age of participants was 32 years, with 52% married or in a committed relationship and 6.5% self-identified as having same-sex relationships. The majority were secular (63%), 21% were traditional (21%), and 16% were religious. In terms of involvement in the ongoing conflict, 35% served in combat, 21% in non-combat roles, and 44% did not participate. Most men (71%) prefer pre-documenting their PSR preferences, with 70% advocating for consent during recruitment for regular military service and 78% before reserve service. Regarding PAR, 37% opposed it at their partner's request, while 47% opposed it at their parents' request. In a multivariable model, the odds of approval of PAR following parental request were four- and three-fold higher among traditional and secular versus religious men (odds ratio, OR = 4.1, 95% CI: 2.0-8.1 and OR = 3.3, 95% CI: 1.8-6.2, respectively) and following the request of a partner, twice higher among traditional and secular versus religious (OR = 2.0, 95% CI: 1.1-4.2 and OR = 2.0, 95% CI: 1.1-3.6, respectively).

Conclusion: While it is understandable that grieving parents seek solace through PSR, consent should be obtained from the men themselves, as a considerable proportion do not support the process as it is currently performed.