My talk on Reproductive Medicine when, where and How during the ACE 2014, @ Indore

1. 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
ACE 2014, INDORE

2. 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
ACE 2014, INDORE

3. ACE 2014, INDORE

4. ACE 2014, INDORE

5. Birthsper1000population
0
5
10
15
20
25
30
35
40
1950-
1955
1955-
1960
1960-
1965
1965-
1970
1970-
1975
1975-
1980
1980-
1985
1985-
1990
1990-
1995
1995-
2000
2000-
2005
United Nations. World Population Prospects: The 2004 Revision. www.prb.org/presentations/g_birth-and-death-rates.ppt. 2006.
Birth Rates Are Declining
Worldwide
ACE 2014, INDORE

6. 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!!!!
ACE 2014, INDORE

7. 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.
ACE 2014, INDORE

8. Partnership Between the Patient, the
ObGyn, and the Fertility Specialist
Fertility
Specialist
ObGyn Patient
ACE 2014, INDORE

9. Vs
Time taken from GP to cardiologist - < 6 hrs
ACE 2014, INDORE

10. Time taken from GP to Reproductive med specialist - > 6 yrs
ACE 2014, INDORE

11. Dr. xyz vbgs: consultant ….
• Obstetrician
• Gynaecologist
• Reproductive medicine
specialist
• Embryologist
• Laparoscopic surgeon
• Foetal medicine specialist
• Oncologist
• Urogynecologist
ACE 2014, INDORE

12. ACE 2014, INDORE

13. Reproductive medicine
• When ?
• How ?
• Where ?
ACE 2014, INDORE

14. ACE 2014, INDORE

15. ACE 2014, INDORE

16. After obstetrics & gynaecology
Endo Gynaecology
Fetal Medicine
Maternal Fetal Medicine
Reproductive Medicine
Uro GynaecologyACE 2014, INDORE

17. ACE 2014, INDORE

18. 2004….after my MS….
Dr.Sadana Desai
Dr.Korula George
ACE 2014, INDORE

19. 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
ACE 2014, INDORE

20. • 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
ACE 2014, INDORE

21. • Counseling
• Listening
• Emotional backup
• Infrastructure
• Cost effectiveness
• Update with the recent evidences
ACE 2014, INDORE

22. Infertility treatment
ACE 2014, INDORE

23. ACE 2014, INDORE

24. Level of care
• Level 1
• Level 2
• Level 3
ACE 2014, INDORE

25. • Minimum eligibility
– OBG- MS/MD/ DNB
– Diploma in OG with DNB
– Why not DGO alone??
ACE 2014, INDORE

26. ACE 2014, INDORE

27. i
ACE 2014, INDORE

28. ACE 2014, INDORE

29. 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..
ACE 2014, INDORE

30. Reproductive medicine
• When ?
• How ?
• Where ?
ACE 2014, INDORE

31. 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
ACE 2014, INDORE

32. ACE 2014, INDORE

33. Training
• Government institutions
• Semi private organizations
• Private multispecialty hospital
• Private clinics
ACE 2014, INDORE

34. DM- Reproductive
medicine
S.No. Course Name State
Name 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 2
Permitted
from 2012-13
u/s 10(A).
29/06/2012
ACE 2014, INDORE

35. ACE 2014, INDORE

36. ACE 2014, INDORE

37. ACE 2014, INDORE

38. 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 upACE 2014, INDORE

39. 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
ACE 2014, INDORE

40. ACE 2014, INDORE

41. Infertility treatment
ACE 2014, INDORE

42. Reproductive medicine
• When ?
– After MS/DNB
• How ?
– University degree
• Where ?
– Evaluate the teacher
who teaches you
ACE 2014, INDORE

43. Success….
ACE 2014, INDORE

44. ACE 2014, INDORE

45. Hearty
welcome….
ACE 2014, INDORE