Unpacking the 'Ice Baby' story

The unexpected media interest generated in our case report in Human Reproduction (June 2004) merits further expansive discussion. Our overwhelmed couple are delighted that the publicity has given hope to other young cancer patients and drawn attention to success achieved within the NHS for which the couple are eternally grateful.

Imagine a teenager in the 1970s facing his mortality at such an early age, whilst wrestling with the option of future procreation, should he by chance survive! Counselling in those early years was left to the sympathetic laboratory staff life experiences giving them the only qualification to discuss the sensitive issues surrounding sperm cryopreservation with the patient. No evidence-based medicine existed to offer anticipated future success rates regarding possible future infertility treatment nor was there legislation in place regarding cryopreserved gametes. Many men were sadly not given the opportunity to bank sperm due to the patchy awareness of the NHS sperm banking facility within the region, and those referred often had only one or two days available to complete banking before treatment commenced.

Our patient was fortunate in many respects. The expert care he received from his oncologist proved curative and his specialist had the foresight to refer him to take advantage of the NHS sperm banking facility. Sadly, a high proportion of men storing sperm in the early years never survived to consider future utilisation. Advances in chemotherapy and radiotherapy in the past 20 years have seen a parallel increase in survival rate and an increase in requests for pre-treatment banking and future utilisation.

Youth was on his side with regards to benefiting from advances in fertility treatment. In 1979 intra-cervical insemination was the only treatment option available with a success rate of less than five per cent at best. In 1983, the NHS Regional IVF Unit was established at St Mary's Hospital with embryo cryopreservation taking place from 1987 and ICSI (intracytoplasmic sperm injection ) from 1994/5. These advances allowed our patient to utilise his sperm to maximum effect.

Guidelines for NHS provision for assisted reproduction were drawn up after joint consultation with the local health authorities in 1983.  These have stood the test of time and were fully endorsed with the recently published NICE guidelines, recommending the option of three complete IVF treatment cycles to couples where the woman is 39 years old or younger.

Our couple embarked upon four cycles of ICSI. Fertilisation and subsequent embryo transfer was achieved in three out of the four cycles. In their final cycle, after disappointment with fresh embryo transfer, success was achieved with replacement of their last remaining viable cryopreserved embryos. This completed the couple's NHS-funded treatment within the Unit, although one ampoule of sperm still remained in frozen storage.  

Moving to the present and taking into account all the advances in infertility treatment, comparable patients may not anticipate similar success if the recent declaration of John Reid, the Secretary of State for Health, is implemented. This would offer couples only a single cycle of IVF within the NHS. Hopefully, however, this will only be a mere stepping-stone to full acceptance and implementation of the NICE guidelines.

For the future, will our twenty-one year record be broken? One of 18 patients who still have sperm stored in excess of 21 years may be contemplating treatment. With the advent of prepubertal testicular tissue cryopreservation, I am sure the record will be broken. Suffice it to say, for now, that a delightful, healthy, little boy has been born as a result of medical advances in treatment and through the fortitude of his parents persisting with their infertility treatment and taking it to the wire, conceiving at their last attempt.

Dr Elizabeth Pease is a Consultant in Reproductive Medicine at St Mary's Hospital, Whitworth Park, Manchester, and was involved in the treatment of the couple who recently went public with the news they had conceived a baby boy using sperm kept frozen for 21 years.