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This paper examines how Islamic moral and ethical frameworks shape the therapeutic landscape and journeys of fertility care in Tajikistan and Uzbekistan, where childlessness carries profound socioeconomic consequences. Drawing on ethnographic fieldwork, including interviews with women, care providers and participant observations in fertility clinics and sacred pilgrimage sites, the study reveals how reproductive aspirations are negotiated through the interlacing of religious normativity, biomedical authority, and vernacular therapeutic practices. Ultimately, fertility care in Central Asia emerges as a contested landscape where Islamic piety and practice, post-Soviet medical subjectivities and conceptions of modernity and globalized biotechnologies are entangled.