In general, a woman's desire to be a mother is more sympathetically treated by society than a man's desire to be a father. Lack of potency or fertility are frequently joked about but the sales of Viagra for the treatment of impotence show it is no laughing matter, unless one has shares in Pfizers, the makers of the drug.
One group of men to whom the possibility of infertility has to be presented are those who develop cancers which require treatment by chemotherapy, radiotherapy or radical surgery which may result in loss of fertility. Testicular cancer is the most common cause of cancer in young men. There are about 80 cases per year for which orchidectomy, the removal of the testes, is the required treatment. Male hormones can be replaced but sperm producing tissue cannot be replaced. Leukaemia and Hodgkins disease, of which there are 200-250 cases per year, and non-Hodgkins lymphoma are all common in Ireland and it is young men who are frequently affected. No one knows the effect of chemotherapy and radiotherapy on the DNA in sperm. Research is needed in this area but we do know that the effects are not for the better.
The technology required to successfully freeze human semen has been available for many years. The development of successful human semen freezing techniques has proved particularly valuable in cases of men with cancers such as those I have mentioned and in men with chronic illnesses which may result in a loss, or potential loss, of fertility. Because it was recognised that Irish men should be in a position to benefit from such techniques, the Department of Health and Children approached the Human Assisted Reproduction Institute in the Rotunda Hospital some time ago with a view to setting up a semen freezing and storage facility. The institute willingly did so, using £60,000 of its own money to buy the required equipment.
The problem is that the need for the service is far greater than expected and looks like increasing even further as doctors and other medical workers hear of the facility. It was expected that there would be 40 to 50 specimens frozen each year. Instead, although the facility has been in place for only a few months, four to five cases are presenting each week. Naturally the unit does not want to turn anyone away but the costs and the need for staff must be addressed urgently.
The service is offered to men between 18 and 45. I will not go into detail about the consent forms they must sign and the counselling they receive but ten men under 25 and 18 between 25 and 45 were seen in the first cohort. At present, patients pay £200 for the initial service and £50 per year for storage.
These men often cannot work because of their illness and they are likely to be out of work for at least six to eight months. Many of those who are ill are relatively young and some have no money. There is no help with finance from the health boards the VHI, BUPA or other insurance schemes. Those who do not have the money are allowed pay later as the procedure must take place with haste because chemotherapy or radiotherapy cannot be delayed. The Irish Cancer Society helps some patients who cannot pay but feels it cannot continue beyond the end of the year because there are many other pressing needs on its money.
Testing for HIV antibodies, hepatitis B and C and other viral antibodies are carried out, as are many other costly medical procedures. Data collection on patients is vital and the secretarial side is as important as the medical, counselling and technological aspects. The HARI Institute has no increase in staff to deal with this facility. It expected the facility to be quite small but it is badly needed.
Oncology social workers are among those who stress the importance of this service, not just from a practical point of view but as a psychological boost for the patient. It seems a positive sign if, in the chaos of cancer, a patient is asked if he would like his sperm frozen in case he would like to become a father in ten years time. In such cases, the patient will think he is expected to survive at least ten years and this is important for rehabilitation — in the midst of stressful treatment the patient has some sense of control over his future. Not all patients will want to become involved in this treatment but there is an anxiety among some of the social workers that the cost may be a deterrent.
Treatments for many cancers are improving all the time. The outlook for testicular cancer has dramatically changed for the better recently. This is important for the parents, spouses or partners as well as for the young man who is ill. All the main hospitals with chemotherapy services — St. James's, the Mater, St. Vincent's and the University College Hospitals in Cork and Galway — use this service. It must be looked upon as a component of modern cancer management. People from one of the hospitals told me that nine young men with testicular cancer were currently undergoing treatment there.
We are notoriously bad at discussing anything to do with sex but, as a doctor and as someone who has spoken frequently on women's health issues, this is an area of men's health we cannot allow ourselves to fail to address. I ask for funding to be made available for young men who will be helped at a most difficult time in their lives by being given some hope for the future.
