Belgium regulates ART through the Law of 15 March 2007 on Medically Assisted Reproduction and the Disposition of Supernumerary Embryos and Gametes (Loi relative à la procréation médicalement assistée et à la destination des embryons surnumé-raires et des gametes), as amended in 2023 (Loi modifiant la loi du 6 juillet 2007 relative à la procréation médicalement assistée et à la destination des embryons surnuméraires et des gametes) (8, 9). The statute was intended to provide legal certainty for fertility practice, given the need to take into account the variety of ethical perspectives and family structures that characterize contemporary ART practice (10, 11).

Before any treatment, each couple must sign a written agreement specifying the intended use of embryos (as well as gametes), including instructions for situations such as separation, incapacity, or the death of one partner, as well as the future of their cryopreserved material after the storage period allowed (10).

The legislation explicitly addresses post-mortem implantation: article 15 allows embryos to be used after the death of one partner if both partners had given explicit consent for such use in the original written agreement mentioned before. Indeed, Article 13 expressly requires that the consent document specifies the intended use of any cryopreserved embryos in the event of the death of one of the partners. Article 16 establishes the temporal limits for treatment: embryo transfer may take place no earlier than six months and no later than five years after the death of the male partner. The six-month period serves as a reflection interval, while the time limit—originally two years and extended to five years by the 2023 law—wishes to maintain a temporal connection with the pre-existing relationship (10).

The Belgian framework thus authorizes posthumous reproduction under conditions of documented, pre-mortem consent and defined temporal limits, and all decisions regarding embryos must be recorded in advance, with patients retaining the right to modify their directives jointly during life.

The French regulation of assisted reproduction, and particularly of posthumous conception, represents one of the most intricate and debated examples in Europe. Its legal and ethical structure is built upon a long tradition of bioethical legislation, beginning with Law n. 94-654 of July 29, 1994, on the donation and use of elements and products of the human body, medical assistance, procreation and prenatal diagnosis, and subsequently revised with the Bioethics Law in 2004, 2011, and most recently in 2021 (Loi bioéthique, 2004, 2011, 2021) (12–15).

Access to ART has been regulated by the Public Health Code (Code de la santé publique). Article L. 2141-2 of the Public Health Code as amended by the 2021 Bioethics Law, explicitly prohibits posthumous reproduction (15): it states that no medical assistance to procreation may be undertaken after the death of one of the members of the couple. This prohibition extends both to posthumous insemination and embryo transfer, and to the storage and subsequent use of gametes or embryos once one partner had died.

The 2021 Bioethics Law introduced major reforms to the French ART system, including the extension of access to single women and female couples (16). While the extension of access to ART marks a significant evolution in the social understanding of family, it did not erode the underlying conviction that reproduction after death lies beyond the ethical and legal boundaries of procreation.

Although posthumous embryo transfer remains forbidden on French territory, individual cases continue to challenge the boundaries of the law through cross-border treatment, most commonly in Spain or Belgium, where the practice is permitted with consent. However, in the recent case of Baret and Caballero v. France, the European Court of Human Rights (ECHR) upheld France's ban on posthumous reproduction, ruling that the prohibition did not violate the right to private and family life under Article 8 of the European Convention on Human Rights (17). The ECHR held that the ban imposed by French law, which prevents the export of gametes and embryos for posthumous reproduction, was legitimate because it pursued legitimate aims, namely the “protection of morals” and “the protection of the rights and freedom of others”: these are concepts that in ECHR case law allow States to regulate sensitive ethical issues and to safeguard the interests of third parties potentially affected by decisions. The ECHR concluded that France enjoys a wide margin of appreciation in making such ethical and social policy choices (18).

In the Greek legal framework, the principal sources are Law 3089/2002 on Medical Assistance in Human Reproduction (Ιατρική υποβοήθηση στην ανθρώπινη αναπαραγωγή) and Law 3305/2005 on the Application of Medically Assisted Repro-duction Methods (Εφαρμογή της Ιατρικώς Υποβοηθούμενης Αναπαραγωγής) (19, 20): the first law mainly replaces the relevant articles of the Greek Civil Law Code, and the second law is complementary to the first one, clarifying some issues and established the National Authority of Medically Assisted Reproduction (21). These instruments define the conditions of access, the forms of consent required, and the ethical boundaries of reproductive practice, and address sensitive issues such as donor anonymity, surrogacy, embryo research, and post-mortem reproduction (21).

According to the law of 2005, when natural procreation cannot occur due to infertility or the risk of transmitting a disease to the offspring, ART is deemed as a medical necessity. Access to assisted reproduction is granted not only to married couples but also to unmarried or cohabiting partners and to single women up to the age of fifty-two. Each procedure must be preceded by explicit written and informed consent, and the parties must determine in advance the fate of any embryos created, particularly in circumstances such as divorce, separation, or death (21).

Article 1,457 of the Civil Code, introduced by Law 3089/2002, allows a woman to proceed with fertilization using the gametes of her deceased husband or partner, as well as the embryo created with him, provided that two cumulative conditions are met. First, there must be prior written consent, expressed in a notarial act, in which the deceased explicitly authorizes the posthumous use of his sperm or embryos created during life. Second, the law imposes a temporal limitation: the procedure may take place no earlier than six months and no later than two years after the man's death (21). The waiting period is intended to ensure reflection, while the time limit reflects an intention to preserve the connection between conception and the existence of a recent, living relationship. Greece allows posthumous reproduction only when clearly premeditated, temporally constrained, and legally valid.

The country's ART framework is governed by Law n. 40 of 19 February 2004 on Medically Assisted Procreation (Norme in materia di procreazione medicalmente assistita), a law that sought to protect “all subjects involved, including the conceived,” while setting clear limits to the use of reproductive technologies (22). Initially, the law was among the most restrictive in Europe, but over the following two decades, constitutional jurisprudence and ministerial revisions progressively reshaped the legal landscape (Constitutional Court rulings 2009, 2014, 2015) allowing more and more applicability (23–26).

A recent development of the regulation was shaped by the 2024 Guidelines for ART, issued by the Ministry of Health in collaboration with the Italina National institute of Health (Istituto Superiore di Sanità) and of the National Health Council (Consiglio Superiore di Sanità), which introduced substantial updates to the interpretation and ap-plication of Law 40/2004 (3). Among the most significant provisions is the possibility of post-mortem embryo transfer (5.4, Guidelines 2024) (3).

These provisions aligned national practice with recent constitutional and judicial reasoning, which emphasized the enduring significance of informed consent as the determining factor in the creation of parental bonds, as expressed already in Article 8 of Law 40/2004 (Cassation Court ruling 13,000/2019, point 7.8.5.1) (27). The guidelines reaffirmed that once consent has been given and fertilization has occurred, it becomes irrevocable (Art. 6, Law 40/2004)—reflecting the Italian legal understanding of ART as a process initiated by a shared and deliberate reproductive project (4, 6).

A seven-day waiting period must elapse between the signing of consent and the fertilization of the oocyte, allowing time for reflection and ensuring that the decision is informed and deliberate; this waiting time between consent and fertilization has been in place since the law's enactment. Physicians and healthcare providers are required to provide comprehensive information to the couple, including the relevant bioethical implications. The 2024 Guidelines do not impose any temporal limitation on the post-humous use of embryos.

The Portuguese framework for medically assisted reproduction is established by Law 32/2006 on medically assisted reproduction (Procriação medicamente assistida), as amended (28). It regulates access to treatment, donation, cryopreservation, embryo re-search, and other aspects of assisted reproduction.

Under Article 22, posthumous embryo transfer is permitted in order to realize a clearly defined and previously consented “parental project”, with no specific mention to a dedicated consent to posthumous use of embryos (29). At the same time, the law specifies that when consent is given by the couple, they should be informed of all benefits and risks embedded in the procedure, as well as their ethical, social and legal implications (Art 14.2). The law provides that the woman can proceed with the embryo transfer after a period considered appropriate for proper reflection and consideration (Art 22.1), a period deemed to be not less than six months, except for critical clinical reasons that will be certified by the physicians overseeing the whole procedure (Art 22.4). The embryo transfer must be done within three years of the partner's death. The article also specifies that psychological support must be made available before, during, and after the process.

In Spain, the legal framework is found primarily in Law 14/2006, on Human Assisted Reproduction Techniques (Sobre técnicas de reproducción humana asistida) and Law 14/2007 on Biomedicine (de Investigación biomédica) (30, 31).

Article 9 of the 2006 law first states that no legal parentage or relationship may be recognized for those children of a man who has died before “his reproductive material” was already in the woman's uterus (32). However, in the following paragraph, the law allows for posthumous embryo transfer when the man has given specific consent for his reproductive material—a thus for their existing embryos—to be used by his wife. This consent must be documented in one of the legally recognized forms: a public deed, a will, or a document of anticipated directives, or the clinical consent document referred to in the same law. The law also sets a temporal limit of twelve months from the date of death within which embryo transfer must take place (Article 9.2) (30).

In the case of unmarried partners, Article 9.3 extends the same possibility: a man who is not married to the woman undergoing treatment may authorize, under the same formal requirements, the posthumous use of his reproductive material (30).

The Dutch approach to posthumous reproduction is governed by a combination of statutory provisions under the Embryo Act (Embryowet) issued in 2002 and detailed professional guidelines issued by medical associations (33). While the Embryo Act itself does not explicitly regulate posthumous reproduction, it establishes general requirements for consent and the lawful use and storage of embryos. Specifically, Article 7 of such Act stipulates that reproductive material must be destroyed upon the individual's death, unless written consent for posthumous storage and use was given during their lifetime.

The legal framework is complemented by professional standards contained in the Guidelines of the Embryo Act (Modelreglement Embryowet), jointly issued by the Dutch Society of Obstetrics and Gynecology (NVOG) and the Association for Clinical Embryology (KLEM)—first in 2004 and then updated in 2018 (34). The 2018 Guidelines provides a structured, practice-oriented interpretation of the Embryo Act and is considered binding on fertility clinics as a professional norm. Chapter 5 addresses post-humous reproduction, defined as any conception occurring after the death of one or both genetic contributors, whether through stored gametes or embryos (34).

Under these guidelines, posthumous use of reproductive material is only permissible where the explicit, prior, and written consent by the deceased exists. In the absence of such consent, retrieval and use are not authorized, and clinics are instructed to destroy the material once the provider's death is confirmed.

The Guidelines also outlines procedural and ethical recommendations: first of all, a twelve-month reflection period is advised between the death of the gamete provider and the initiation of fertility treatment using the material. This is because there is a psychological instability that follows a partner's death, and although it is very personal, the regulation claims that after twelve months it is clear whether the grieving process has come to a resolution (Embryowet, 5.5) (34). During this time, psychological counselling should be offered. The time limit for the procedure is the time limit in terms of age for all women to access the procedure, which is 49 years old.

The United Kingdom represents one of the most comprehensive and precisely regulated systems of assisted reproduction in Europe. Its framework is defined by the Human Fertilisation and Embryology Act 1990 (Human Fertilisation and Embriology act 1990), as amended by the Human Fertilisation and Embryology Act 2008 (Human Fertilisation and Embriology act 2008) and implemented through the work of the Human Fertilisation and Embryology Authority (HFEA) (35, 36). The HFEA, established in 1991, acts as the national independent regulator for fertility clinics and embryo research. Its authority extends to licensing, monitoring compliance, and ensuring that the use and storage of gametes and embryos occur only with proper consent and within clear temporal and ethical boundaries.

At the core of the UK system is the principle of informed, written, and specific consent. Before any treatment or storage can occur, couples must complete legally prescribed HFEA forms specifying how their embryos may be used, for how long, and under what circumstances. In the UK, consent can be withdrawn at any time up until an embryo is transferred into the womb; if an individual wishes for his partner to use their embryos after his death, he should name his partner on the specific consent form. The HFEA requires physicians to ensure that individuals fully understand the implications of their decisions and to offer counselling prior to consent.

The regulatory framework explicitly addresses posthumous use of gametes and embryos. The law allows for the use and storage of reproductive material after death, provided that the deceased has given explicit written consent prior to their death. This consent must specify both the use and continued storage of embryos after death and name the partner who may use them. Without this explicit authorization, posthumous use is prohibited, and any embryos in storage must be destroyed once they can no longer be lawfully held (37).

According to the HFEA guidance (Consent to Treatment and Storage, updated 2022), where valid consent has been given, embryos may remain stored for up to 10 years following the individual's death, exclusively for use by the partner named on the specific consent form. After this period, they must be removed from storage and disposed of. The deceased may also consent to shorter storage periods, or to the use of their embryos for training or research purposes after death. The system relies on the clarity and validity of consent forms, which function as legal instruments of posthumous intention.