Institute of Reproductive Medicine & Women’s Health (IRMWH)

   

   Dr.Thankam Rama Varma, Ph.D.,FRCS, FRCOG

Inspiration behind the institute.
Dr.Varma is a leading international figure in modern gynaecology, obstetrics and reporductive medicine. As a consultant at St.Georges Hospital and Medical School, one of the biggest teaching hospital in UK, she created history by becoming the first female surgeon in the 250 years old institution.

When she left St.Georges Medical School she was awarded for her outstanding contribution to service teaching and training, a Varma annual lecture which is delivered by outstanding scientist, or academicians and highly acclaimed educationalist. A Varma Award to the best outgoing undergraduate student from the St.Georges Medical School was also given.

In year 2000 she took the responsibility of setting up a center of excellence for service, teaching and training for Madras Medical Mission. It started in a small humble way in January 2000, mainly looking after couples who are childless. Every year new services were started and now the unit can offer total care for women and her babies, which includes a state of the ART fertility service, high-risk pregnancy care, an excellent neonatal intensive care unit, gynaecology, obstetrics, breast care unit, endocrinology, urogynaecology, surgical oncology, endoscopic procedures, development clinic, paediatric and neonatal surgery, supported by high level ultrasound services. Her special interest is Reproductive Medicine and High-risk pregnancy and specialized in these two sub specialities.

The unit is proud of delivery of more than 5000 babies to its credit since its inception in year 2000.

Twenty clinicians are qualified and awarded the Post Doctoral Fellowship in Reproductive Medicine. Many papers and projects were written and published by the Fellows and presented at national and international levels. The unit is acknowledged for its excellent teaching, training and excellent service and care to women and her babies.

The Institute of Reproductive Medicine and Women’s Health was started in 1999 as the second unit of MMM. Having consistently maintained high clinical and academic standards, it remains one of the leading centers’ of excellence in India.

The staff believes strongly in honesty transparency high level ethics and that the cure is complete only with good care. We take time to listen to and make our patients feel special. By explaining options, risks and benefits, advantages and disadvantages of their treatment we empower our patients and their families to make an informed choice. We take every effort to maintain patient confidentiality and privacy.

This is a post-graduate teaching centre with on-going training programmes in Reproductive Medicine and embryology. We have conducted sixteen major annual international conferences successfully.

Our Mission is to provide appropriate care to all and bring the latest breakthroughs in the field of reproductive medicine and women’s health to our patients. Dr. Thankam Varma, PhD, FRCS, FRCOG is the founder and inspiration behind the institute. Under her able guidance the unit is well staffed with highly qualified and experienced specialists and allied health professionals.

Assisted Reproduction

We believe in a holistic and ethical approach to deal with all aspects of sub-fertility including 3rd party reproduction. This is a tertiary centre that receives women from far & wide. We have consistently received good feedback from our patients. ART Programme is well supported by 4 Full-time highly skilled consultants and trained embroyologists. The following are some of the services that aid couples desiring childbirth to achieve their aspirations:

  • Intra Uterine Insemination (IUI)
  • In Vitro Fertilisation & Embryo Transfer (IVF & ET)
  • Intra Cytoplasmic Sperm Injection (ICSI)
  • Testicular Biopsy (TB)
  • PICSI (Physiological ICSI)
  • Testicular Epididymal Sperm Aspiration(TESA)
  • Percutaneous Epidydamal Sperm Aspiration (PESA)
  • Blastocyst culture and transfer
  • Laser Assisted Hatching
  • Frozen Embryo Transfer
  • Sperm Freezing
  • Oocyte freezing
  • Embryo Freezing
  • Egg Donation
  • Sperm donation
  • Embryo Donation
  • Surrogacy

Obstetric Service

Care for women throughout their pregnancy, delivery and post-delivery period is provided with skill and compassion by the entire team of nurses & doctors. All deliveries are attended by neonatologist to give the newborn its best start.

There is a well organized, state of the art service for both ‘high-risk’ and ‘low-risk’ pregnancies. Health problems may have either existed before the pregnancy or can occur for the first time during the pregnancy. Such pregnancies are called “high-risk”. Our unit has a range of facilities and experienced clinicians, to successfully manage many different pregnancy complications.

Our Feto-Maternal specialists are skilled in looking after all types of pregnancy complications. They work as a team, with doctors from several specialties such as Anesthesiology, Genetics, Endocrinology, Diabetology, Cardiology, Gas troenterology Renal Medicine, Microbiology and General Surgery.The hospital has excellent highly acclaimed pediatric cardiology unit.

Our Lab services to provide the internationally accepted standard of care for all pregnancy complications and outstanding support from all the laboratory units such as blood bank, bio chemistry , micro biology , pathology, cytology, infection control team Facilities for performing genetic tests are available at our hospital itself.we have an excellnat pathology service which is valuable when assessing fetus and placenta in pregnancy loss and certain pregnancy complication. Neonatal Intensive Care Unit (NICU) as part of IRMWH ensures that newborns from 24 weeks can be cared for.

Diagnostic Ultrasound

IRMWH offers a good quality diagnostic imaging service including the latest 3 & 4 Dimensional scan (3-D, 4 - D).Several different types of scans are required to fully evaluate a women’s’ health problem. Women who come to IRMWH receive a ‘one-stop service’ that includes Obstetrical and Gynaecological doctors review, relevant investigations including ultrasound assessment all under one roof.

1. Early pregnancy scan:

a.Scan to assess location (intrauterine - within the womb / extrauterine - ectopic pregnancy) and duration of pregnancy (gestation)
b.Ultrasound to assess complications in early pregnancy like bleeding, pain etc.

2. Down’s Syndrome screening:

a.11-13 weeks Nuchal translucency scan and double marker test
b.Scan at 16 - 18 weeks + blood test (Quadruple test).
c.We have non-invasive test to check for chromosomal abnormalities.

3. Cervix scan

- to assess for risk of Preterm labour (delivery before 37 weeks).

4. Anatomy scan

- for a detailed evaluation to assess for fetal structural defect (Congenital Abnormalities) at 18-20 weeks of pregnancy.

5. Fetal Well-being scans

Approximately 10% of pregnancies can be complicated with fetal growth problems (small for gestational age fetus/ growth restricted fetuses). Gowth and Doppler scans are vital in the care of such high risk pregnancies.
a.Uterine artery Doppler - to assess for blood flow to placenta.
b.Amniotic fluid index – to check for amount of fluid (liquor) around fetus.
c.Umbilical artery Doppler – helps check placental blood flow to the fetus.
d. Growth scan - to check fetal size.

6. A fetal echo

is a scan performed when a heart abnormality is suspected. Paediatric Cardiologists at the Institute of Cardiovascular Diseases, scan and also fully explain the findings and treatment plan to patients and relatives, when a heart defect or rhythm defect ( slow heart beat / congenital heart block) are detected during pregnancy.

7. Scans for multiple pregnancy (Twins, Triplets)

require a whole range of very specialised scans and all these are performed at IRM WH
– Type of multiple pregnancy (Chorionicity)
- Nuchal translucency scan for downs syndrome screening
- Anatomy scan to perform a detailed assessment of fetuses for structural defects as twins are at higher risk of abnormalities.
- Monochorionic twins require 2 weekly scans from 16 weeks – 28 weeks to check for a condition called Twin to twin transfusion Syndrome.
- Fetal well being assessment with growth, fetal doppler studies are essential part of multiple pregnancy care as fetal growth restriction occurs in about 30% We have extensive experience in this area.

8. Dr Suresh inaugurated the fetal medicine unit at IRMWH in January 2017. The service in fully supported by fetal medicine consultant, ultrasound consultant, clinical geneticist and a well equipped genetic laboratory.

9. Scans for the newborn:

Ultrasound facilities are available both in the neonatal unit and at the outpatient clinic.
- Neurosonogram - to check details within the newborn’s head,
- Abdominal, Renal and Pelvic scans - to check details within the newborns‘ tummy ( Abdominal/ Renal scan)
- Scan to follow-up progress of preterm, growth restricted newborns and those with structural defects.

Our imaging department offers the following services

  • Gynaecology Scans
  • Sub-fertility scans
  • Limb Doppler studies
  • Thyroid scan
  • Breast scan
  • Abdominal scan
  • Ultrasound for newborns

All the scans are done by highly skilled dedicated, experience and committed consultant specialized in ultrasound the welfare of mother and her babies.

Neonatology

Neonatology is a subspecialty of Paediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant.

At IRMWH we have a planned approach to pregnancies with added risk: Obstetrician and Neonatologist are involved in planning and optimal care from before birth at periodic intervals.

Our Neonatal Intensive Care Unit (NICU) is equipped with state of the art equipments meeting all national/international standards. The unit is covered round the clock by trained team of doctors, nurses. Our unit has been successfully managing extremely small Newborns. Being a tertiary referral centre in Paediatric Cardiology, we have managed several newborns with congenital heart conditions as a team along with Paediatric Cardiologists.

  • Antenatal counselling
  • Neonatal intensive care
  • Newborn screening ( Metabolic + Hearing Screen )
  • Lactation counseling and assessment
  • Neonatal surgery
  • Neonatal transport services
  • Newborn Follow up clinic
  • Child development clinic
  • New born and childhood Vaccination
  • Paediatric clinic

All babies undergo hearing and newborn screening before discharge from the hospital. We have an excellent development clinic to access of progress of babies born too soon or too small or with anomalies. We can transport and receieve sick babies in excellent mobile NICU ambulance from the referral hospital to our unit.

Gynaecology

IRMWH is well equipped with facilities to care for all outpatient and inpatient gynecological health needs. A well equipped theatre and postoperative care facilities are available for the various surgical procedures including complex highly specialized operations like pelvic floor reconstruction and oncoplastic surgery. We promote cervical and breast screening for all women as it can help & identify changes well before cancer can set in.

  • Adolescent gynaecology
  • Pre-conception clinic
  • Menorrhagia clinic
  • Menopause
  • Endocrinology
  • Oncology
  • Conventional surgeries
  • Endoscopic surgery (Laparoscopic & hysteroscopic)
  • Total health screening for womwn and girls
  • Breast screening programme
  • Cancer Screening Programme & Human Papilloma Virus (HPV) Vaccination programme

Urogynaecology

Urogynaecology is a relatively new super-specialty that deals with pelvic floor disorders in women. 50% of women over the age of 35 suffer from some form of pelvic floor disorder. To maintain normal bladder function a structurally normal urinary system and its function control regulated by the brain, nerves is needed. Failure of any of these can give rise to urinary problems.

Most women with urogynaecological problems are embarrassed to seek medical help and suffer in silence. Several Treatment options like life-style modifications, bladder re-training, pelvic floor exercises, use of pessaries, pharmacotherapy, conventional surgery and minimally invasive surgery can help in successful treatment. The three main types of urogynaecological problems are:

Three out of 10 women with urinary problems have some form of urinary incontinence. Presentation varies from urinary leak on cough, sneeze or exercise (Stress incontinence), or frequency of urination, urgency and urinary leak associated with urgency (Urge incontinence) or a combination of both (Mixed incontinence). Occasionally some can develop a continuous leak of urine either following a difficult labour, surgery or radiation (Fistula).

In the peri-menopausal women, the hormonal change along with the laxity of the tissues gives rise to pelvic organ prolapse. Pelvic organ prolapse can give rise to variety of symptoms ranging from dragging sensation, feeling a lump, difficulty in walking, sitting and restricting movement. Due to the close relationship of the lower urinary tract with the genital tract, patients with pelvic organ prolapse are likely to have urinary and bowel problems as well. Recurrent urinary tract infection is a common problem in this age group. The most dangerous symptom requiring immediate evaluation is haematuria (blood in the urine) in all age groups.

Pelvic floor problems occur more commonly in women compared to men. The reason being, normal changes in a woman’s life damages the pelvic floor – such as pregnancy, childbirth, menopause. In addition in the presence of chronic cough, constipation or obesity the damage gets aggravated.

Anal dysfunction can present with faecal urgency or incontinence. Patients are too often embarrassed to discuss this with the doctor and often present late. Anal dysfunction can occur secondary to a difficult labour, pelvic floor surgery or radiation.

All pelvic floor dysfunction considerably affects a woman’s quality of life. Unfortunately, most fail to seek medical help either due to embarrassment or due to the myth that it is part of the ageing process and nothing much can be done about it. Medical science has progressed by leaps and bounds and several Treatment options are available for these urogynaecological problems.

IRMWH Specialist Breast Care

IRM Specialist Breast Unit is one of the few comprehensive dedicated centre in Tamilnadu for the evaluation, diagnosis and management of all breast conditions.

In India, as Breast Cancer incidence is on the rise and is due to become the commonest cancer amongst Urban women, early diagnosis is the key to achieving cure with good quality of life.

Services provided include ‘One Stop Breast clinic’ offering ‘triple assessment’ for symptomatic women, which is the international standard for diagnosis of breast conditions including Clinical examination, Ultrasonography, mammography (above 35 years) and pathology (FNAC or Core biopsy) are done during a single visit.

The centre also provides a breast screening service for all women from the age of 40 years with annual mammography including providing a definitive diagnosis by ultrasound or mammogram guided stereotactic biopsy for screen detected abnormalities.

The comprehensive breast care services include Oncoplastic breast preserving surgery for breast cancer & cosmetic breast surgery like Breast reduction & Augmentation mammoplasty.

The centre aims to increase breast awareness in women through specific programmes and reduce the burden of breast cancer in our society which is increasingly becoming an epidemic due to the modern life style of the urban Indian woman.

Teaching and Training

This centre is recognized by the Tamil Nadu Dr. MGR Medical University and the National Board of Examination, New Delhi for fellowship program in Reproductive Medicine due to its excellent academic activities. Twenty doctors were awarded the fellowship degree in Reproductive Medicine by the National Board of examination Delhi and Dr.MGR Medical University.

  • We offer post doctorate fellowship training in Reproductive Medicine
  • We have one year fellowship training in Embryology and Reproductive Medicine. M.M.M. Council will award the fellowship certificate. Doctors with DNB or MD with 2 years experience and scientists (Msc in Biotechnology or biology) can apply for the training.

Regular CME sessions are conducted every 2 months focusing on clinically topics relevant to excellent care to women and her children.Our annual conference and the CME sessions in the last 16 years has remained very popular among clinicians in India and abroad.

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