IN SPRING a young man's fancy turns to love though not necessarily to the thunder of tiny feet. But when 24 year old Peter Dowdall met Kate O'Brien in spring last year his biological clock was already ticking. Some months earlier Peter had deposited his still healthy sperm in a sperm bank in Britain before beginning a course of chemotherapy at the Bon Secours Hospital in Cork.
His stored sperm has a 10 year shelf life. "Let's say I would never have sought such a time limit, but I'm very glad of the opportunity I've been given," he says.
Peter's countdown began in October 1994 when he noticed a lump on the right hand side of his neck which he thought was due to swollen glands. He had a sore throat, found it hard to swallow and felt unusually tired. Then aged 22, a horticulture graduate, he assumed a course in antibiotics would put things right. But instead of shifting, the lump grew rapidly. A hospital biopsy revealed Hodgkin's disease, a cancer of the lymph system, and further tests showed that the disease had entered the bone marrow. Chemotherapy was inevitable.
"Things were moving very quickly," says Peter. "I suppose I was in a state of shock. But I wasn't thinking oh God, I've cancer, I'm going to die, I knew it was serious, but I was also told it was treatable.
"When my oncologist began discussing side effects of the treatment, he mentioned possible hair loss and nausea which I knew. Then he said there could be loss in fertility due to my sperm being affected by the chemotherapy, and explained that I would have the option of banking my sperm. I hadn't known anything about this at all. Then I learnt we have no sperm bank here, I would have to go to England for the procedure. The hospital was very helpful and arranged everything."
Peter spent a week in a hospital in Northampton before returning to Cork to begin his chemotherapy.
"I found it horrific. I lost half my hair, had high fevers, and was sick for three days after each session. I began going to a reflexologist in Cork which helped an awful lot. The chemotherapy was successful. The treatment was meant to last from December 1994 to December 1995 but they were able to discontinue it last September. Later I had radiotherapy as a precautionary measure.
In spring last year, Peter met Kate at a party. "People who didn't know him told me not to go out with him", she says. "They said he had just broken up with someone else and that he was sick. He said to me take me or leave me, you're seeing me at my worst."
They've been going out together ever since and are working together in Jersey this summer.
One of a family of seven, Peter says he would love children of his own some day. A sperm count is the only accurate guide to his fertility, and he has been advised not to take such a test until a year after ending treatment. With a good result, his wife could conceive his child in the normal way.
But if the outcome is not good, Peter would become a biological parent only by drawing on his sperm bank. This would involve travelling to Northampton where his wife would have to undergo tests, and where both would receive counselling before she was artificially inseminated with his sperm.
"We don't know how many attempts we could have, we don't know how successful we would be," says Peter. "Ultimately it could be all for nothing".
Over the months Peter Dowdall became increasingly critical of the lack of sperm bank facilities in Ireland.
"At first, when I was better, I wanted to put this whole thing behind me. But I kept thinking about this Irish kid I'd heard about when I was in Northampton. He was only 12, he was really too ill to make the journey, but had to come from Dublin to bank his sperm in England before his treatment. I felt it was terrible putting a child through that.
"In my own case, on top of being diagnosed with cancer, starting treatment and feeling terrible. I had to take myself off to England. But I was lucky. I was well enough to travel. We could pay. Having to travel at short notice is most expensive the flight cost over £300, hotel £400, the week came to the best part of £1,000. Strictly speaking the hospital charges are £100, plus £50 a year storage fee. But they didn't charge me a penny, they were full of goodwill and could not have been nicer."
THE commonest male cancers are lung, skin, colorectal, bladder, stomach, non Hodgkin's lymphoma, oesophagus, leukaemia, testicular and penile. The cancers affecting a young man's fertility are primarily Hodgkin's disease, leukaemia and testicular cancer, and there are other physical illnesses and disabilities such as diabetes or multiple sclerosis which can have a progressive effect on potency.
A look at services for infertile couples is timely in that the average male sperm count has halved over the last 50 years, due mainly, it is thought, to environmental causes. Ten per cent of the Irish married population have infertility problems, half of which are male oriented.
About six years ago the Rotunda Hospital, Dublin, opened an IVF centre for infertile couples. It deals with fresh semen only and with partner rather than donor sperm. Six months ago the hospital extended this service by offering a procedure called ICSI Intra Capsular Sperm Injection geared for men with a poor sperm count. The next step they envisage is to offer a service to men with no sperm by surgically aspirating semen from a blocked was.
The Rotunda was recently approached by the Department of Health with a tentative inquiry regarding the setting up of a sperm bank here.
"We could be the logical site for such a facility," says Dr Peter McKenna, Master of the Rotunda, "because of the technology that already exists. We would have no problem with it. Some people tend to see all the pitfalls and problems surrounding such a service. We tend to look at the needs of the patients and see how we can best help them."
The Dublin Well Woman Centre has been offering a donor insemination service using frozen sperm for a number of years, and last October expanded this into a separate service.
"We know from people contacting us that there is a very great need for a sperm bank," says Well Woman chief executive Anne Brockhoven, "and we would be very eager to offer such a service. We feel we are well placed to do so.
Six months ago Peter Dowdall began contacting politicians and medical bodies about the lack of an Irish service, and has had a positive response. Cork oncologist Dr Gordon Mullins says he speaks for many of his peers in supporting the opening of an Irish sperm bank.
"I think there is a very definite recognition of the need today. We now have increasingly successful treatments of the young male cancer patient. But the treatment carries significant risk of sperm sterility which has implications for young men who would like to have their own family at some time in the future."
The Hodgkin's United Group (HUG) which has 450 members also supports Peter Dowdall's campaign. "It's a very big issue with us," says HUG chairperson Isobel Thompson, Hodgkins disease typically affects young men aged 15-24 who have all their future before them. We know some people go to Belfast, Manchester or Northampton to deposit sperm but most young men are not very vocal about this, and it's mainly through the parents we hear that the problems are.
A facility in Ireland would make the decision much easier and much less expensive."
DR JAMES Clinch, chairman of the Ethics Committee of the Irish Medical Council, says as yet they have no guidelines on sperm banks. With regard to reproductive medicine issues generally, the council has looked to the Institute of Obstetricians and Gynaecologists for guidelines and has accepted its recommendations about IVF.
"The institute has tried to get the Department of Health to regulate IVF such a body might look at sperm banks also, but this has not yet happened," says Dr Clinch.
An Irish sperm bank obviously raises new ethical and legal issues. There is also the question of who would run such services. Of the 63 IVF clinics in Britain, about 60 are already in private, profit making hands. Nothing wrong with this in itself, but it underlines the need for high standards and careful monitoring to protect vulnerable couples desperate to have a child.
While lack of resources has been cited as another reason for slow progress, our religious ethos is obviously a factor. Current Catholic Church teaching rules out any type of assisted conception. An attempt in the late 1980s to set up a sperm bank in Galway was vetoed.
On June 6th, the Minister for Health, Mr Noonan, announced in the Dail that his Department had begun a detailed examination of the possible provision of an Irish sperm bank. He said meetings had already taken place to discuss costs and location. However, his statement also hinted that any initiative may be later rather than sooner. "Any proposal in the area of reproductive health involves ethical issues and the question of whether any legislation would be necessary must also be assessed," he said.
Peter Dowdall frets at such political speak. "How long could we have to wait?"
He himself now has a clean bill of health. "I'm in remission and if I don't get sick within five years, I can consider myself cured. There are changes. I pick up infections far easier, and they're harder to get rid of. But other than taking reasonable care of myself, I don't think about it. I have got on with my life thanks to the hospital, the support of family and great friends. I believe your mental attitude has a huge effect on how you do.
"Regarding the church's position, I think the intent is important. Our intent is to have a family. It is the church that tells us to increase and multiply. All I want is to have facilities in Ireland to have a family in Ireland. What can be wrong with that?"