Reproductive medicine when, how, where

Dr.Raju Nair MBBS, MS ( AFMC), DNB, MNAMS, Fellow Reproductive Medicine(CMC Vellore)

• Reproductive Medicine Consultant Matha Assisted Reproductive Centre (m.arc)Matha Hospital, Kottayam, Kerala

• Member- ESHRE, ASRM,ISAR, FOGSI, IAGE,ACE,IMA

• Reviewer : Cochrane network- sub fertility group

• Scientific publications :11 original articles at indexed journals

• 3 national best papers• Invited speaker to many national

meetings

Training in Reproductive medicine: When, how and where

Dr.Raju Nair MS, DNB, MNAMS, Fellowship in Reproductive Medicine (CMC Vellore)

Reproductive Medicine Consultant

Matha Assisted Reproductive Centre(m.arc)

Matha Hospital, Kottayam, Kerala

Greetings from

gods own country

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1950-1955

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United Nations. World Population Prospects: The 2004 Revision. www.prb.org/presentations/g_birth-and-death-rates.ppt. 2006.

Birth Rates Are Declining Worldwide

Scope of the Problem

• 2-3 million couples

• 13-15% of reproductive age couples

• 40% seek medical care

• 25% seen by subspecialist

• 25% of total pharma growth in infertility drugs!!!!

Definition

• Reproductive medicine is a branch of medicine that deals with prevention, diagnosis and management of reproductive problems

• Goals include– Improving or maintaining reproductive health – Allowing people to have children at a time of

their choosing.

• It is founded on knowledge of reproductive anatomy, physiology, and endocrinology, and incorporates relevant aspects of molecular biology, biochemistry and pathology.

Partnership Between the Patient, the ObGyn, and the Fertility Specialist

Fertility Specialist

ObGyn Patient

Vs

Time taken from GP to cardiologist - < 6 hrs

Time taken from GP to Reproductive med specialist - > 6 yrs

Dr. xyz vbgs: consultant ….

• Obstetrician• Gynaecologist• Reproductive medicine

specialist• Embryologist• Laparoscopic surgeon• Foetal medicine specialist• Oncologist• Urogynecologist

Reproductive medicine

• When ?

• How ?

• Where ?

After obstetrics & gynaecology

Endo Gynaecology

Fetal Medicine

Maternal Fetal Medicine

Reproductive Medicine

Uro Gynaecology

2004….after my MS….

Dr.Sadana Desai

Dr.Korula George

ART specialist ?

• Fixed working hour• Can spend time with family• No labour room duty• No stress• Over expectations• Media publicity • High pay package• International meet , glamour etc etc

Many believe that ART is an easy job

• Infertility involves suffering, anxiety and insecurity and it is the physicians task to ensure that such distress is minimised during the diagnostic and treatment phase

• One of the primary tasks of the physician is to provide information

Patient centered care

• Counseling• Listening• Emotional backup• Infrastructure• Cost effectiveness• Update with the recent evidences

Infertility treatment

Level of care

• Level 1

• Level 2

• Level 3

• Minimum eligibility– OBG- MS/MD/ DNB– Diploma in OG with DNB

– Why not DGO alone??

i

Practical situation….

Specialist having good OG practice…its time to relax …lets start IVF unit…

no time to spend in learning….at this age!!!!

Just ask one simple question to your self..if your husband is down with chest pain..where you rush

GP , general physician or interventional cardiologist??

What next ?Better option …. Keep away..don't do harm to the patient…or place good educated person for the job..

Reproductive medicine

• When ?

• How ?

• Where ?

How good is our present MS –OBG training programme*

• USG- TVS experience• Laparoscopy skills• Understanding the reproductive endocrinolgy

• Scope for using hormone preparations

• Knowledge of ART among teachers who teach MS -OBG

Training

• Government institutions• Semi private organizations• Private multispecialty hospital• Private clinics

DM- Reproductive medicine

S.No. Course Name StateName and Address of Medical College / Medical Institution

University Name Management of College

Year of Inception of College Annual Intake (Seats) Status of MCI

Recognition Date of LOP

1 DM - Reproductive Medicine

Madhya Pradesh

Sri Aurobindo Medical College and Post Graduate Institute , Indore

Devi Ahilya Vishwa Vidyalaya

Trust 2003 2 Permitted u/s 10(A). 05/07/2012

2 DM - Reproductive Medicine

Tamil Nadu

Sri Ramachandra Medical College & Research Institute, Chennai

Sri Ramachandra Deemed University, Chennai

Trust 1985 2Permitted from 2012-13 u/s 10(A).

29/06/2012

Curriculum – CMC vellore• 2 year programme: ( 24 months )

– Reproductive medicine department- 18 months• OPD• USG• Laparoscopy

– Urology – 2 months• Andrology• Male sexual dysfunction• Hysteroscopic procedure

– Genetic lab – 1 month• PCR• DNA sequencing

– Endocrinology – 2 months• Reproductive endocrinology

– Andrology lab – 1 month• Semen analsysis• Semen preparation

– Embryology lab- 2 months• Mechanics of inventory• QC/ QM of lab• Trouble shooting• Embryology procedure• Grading of embryo

• Entrance exam• Only 2 seat / year• Thesis • Journal club• Seminar• Paper presentation• Research methodology

workshop• Scientific publications• Exit exam with external

examiner• Medical college set up

Fellowship courses – Pvt firms

• Main drawbacks…• Cheap laborer• Media publicity• No adequate case load• Teachers qualification• No structured training• No standardization of protocols• No accreditation • No proper entrance / exit exam• Not much interaction with others• Ethical aspects

Infertility treatment

Reproductive medicine

• When ?– After MS/DNB

• How ?– University degree

• Where ?– Evaluate the teacher

who teaches you

Success….

Thank You

Hearty welcome….

ACE 2015 @ cochin