The Realities of Being a Poor Responder


For the two years Wura was trying to conceive naturally, practically every one she knew preached the gospel of IVF, but that was a taboo topic as far as her husband, Austin, was concerned. “If we are not going to get the babies the way God meant babies to be created, then I’m not playing God, after all I did not create myself.” That was his favourite comeback, every time Wura told him about yet another person who had told her about IVF.

So, for two years, while those close to her begged her to try IVF, she begged her husband, who was not even paying any attention. His faith was that strong.  However, one day he changed his mind, or rather, his mind was changed for him. One of his mentors had casually dropped the idea of assisted reproductive techniques with him and, as usual, he had parroted his statement of not playing God.

The man was shocked that Austin, being an educated man, would say such a thing. That was when he learnt about a part of his mentor, that he had not known about before. His mentor had opted for IVF for his second child. He and his wife had waited for seven years, until they tried IVF and got successful on the second cycle. He told him he had not been playing God by trying IVF, but merely making use of the resources God had given to mankind. He added that he waited for more years that Austin had waited for a child, so he knew what he was talking about.

That revelation so gingered him, he wanted to see an IVF specialist the next day. This was a man, who hadn’t gone with Wura to a regular Ob/Gyn, nor submitted himself for any investigations, who now wanted to go straight to IVF. It was a total turn around.

But it was a step in the right direction. When they finally got to see a doctor, it turned out that their doctor wanted to do a full assessment, something they had never done before, but Austin kept hinting they wanted to do IVF, while the doctor kept saying the result of the assessment would determine what action they would take.

With a now on-fire husband, Wura literally took a back seat and let him run the show, which was a good…and a bad thing. Good, because he got first-hand information about every step of their treatment, bad because he worried so much about losing valuable time, and that affected her too.

After their first round of tests, there were needs to do some more investigations on Wura and that was when it was discovered that she had poor ovarian reserve, there were signs of adhesion in both tubes, and her cycle had a tendency to jump and skip,  suffice to say, they were a perfect fit for the IVF which Austin had been clamouring for.

To get the process started, Wura was asked to lose a few kgs and by the end of a month of dieting and some low impact exercise, she lost more weight than was her target, but it was still within healthy range, and that was when the down regulation started.

She started the shots, and when she started her stimulation shots, she went for a scan and for all the follicles the doctor saw, she might not have been on any meds at all. There were little to none! Now, it was pretty much confirmed that she was a poor responder. The dosage of the medications was increased but she was also monitored more closely too, after all OHSS was still a risk.

It was with high hopes that she went to the clinic from work, for a follow-up scan. Hope of seeing more follicles, but unfortunately, she was disappointed. Her ovaries were quite sluggish in responding to the stimulation drugs.

That became her story for a while; even with the highest dose of stims, they were only to be able to get a meagre 3 eggs during egg collection. It was way less than the couple and their medical team had expected.  Poor response of this nature to stimulation was not something they had factored in at all, when they started the IVF journey.


Wura was 28 years old as at that time, right in the prime of her child bearing years. But it turned out from her Anti-mullerian hormone (AMH) blood tests, she fell into the category of women whose eggs had aged prematurely. Why? There were no direct answers, but the answer was not even as important as getting a baby in spite of the condition.

You see, poor responders do not respond well to the IVF ovarian stimulation protocol by making a good number of mature follicles and that’s often because their ovarian reserve is low. However, that condition impacts negatively on IVF, as the less mature follicles means less eggs retrieved, which results in lower numbers of embryos and less chance to have one that is going to turn into a baby.

By day 3, when the embies were transferred, they were only two which had fertilised and they were not top quality either, but they were good enough, so said their doctor.  So Wura and her husband went for that drive early that morning, which was a public holiday, and got the eggs transferred. Her fingers were crossed the whole time, as she watched on the screen as the embryos were dropped, and with every fibre of her being, she wished them to implant.

They did, at least she got a BFP when she tested but it ended in tears two weeks later, then she started bleeding and her precious babies were gone. She did not even get to know, how many she was carrying. They just went.

It was in their grief, less than two months later, that they started the process for another IVF cycle. Again, she had go through the process of giving herself painful shots day-in-day-out, as they were no frozen embies to use.

With her history, her dose from the very beginning was high and she was closely monitored to prevent OHSS. She went religiously for her twice-a-week scan and then it was time to retrieve the eggs. They got four eggs this time, and that was after several weeks of daily shots.  

Illustration showing stages in human embryonic developmentFertilization was done and, this time, they waited for the embies to develop to blastocysts and they got lucky, all four survived the process, out of which three were transferred.  At the end of the 2WW, they got a BFP and by six weeks, it was confirmed that they were carrying twins. However, when they checked again at 12 weeks, one of the gestational sacs had become empty but one baby was going stronger and its heartbeat sounded like that of a warrior’s.

Austin and Wura were sad on one hand at not having twins any more, but happy that they had one healthy baby that had come this far. That baby survived the nine months and put an end to their over three years of waiting.

Aside from poor ovarian reserve, advancing age has also been noted as one the reasons some women need higher doses of stimulation drugs and might still end up producing low quantity and quality eggs. But, it is still possible to have live births from poor responders, as Wura’s case had shown, although the margin is always less, compared to women who respond well to stimulation.

Whatever be the case, having healthy babies at the end of the day, makes the whole difference.

On that note, I’m sending you truckloads of baby dust and Godspeed.





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