You’ve probably heard of the term “ovarian reserve,” but maybe not “antral follicle count (AFC).” Well, put simply, AFC is another way to determine your ovarian reserve, and, in combination with bloodwork, it can provide a helpful snapshot of your fertility potential.
So, how do you find out what your antral follicle count is and what it means for you? We spoke with Reproductive Endocrinology and Infertility Specialist Dr. Jessica Ryniec to help break it all down, so you know what all of the numbers and acronyms mean when you head to your next fertility appointment.
What is an ovarian reserve?
Your ovarian reserve is a measure of how many eggs are remaining in your ovaries. This number is always decreasing, which explains why our fertility declines as we get older.
“Women are born with all of the eggs they will ever have, and that number goes down over time even while on birth control, pregnant, breastfeeding, or otherwise not ovulating,” explains Dr. Ryniec.
OB/GYNs and fertility specialists use ovarian reserve testing to get an idea of what your egg status is and to obtain an estimate of how many you may have remaining.
Ovarian reserve testing typically includes three main markers:
Antimullerian Hormone (AMH) — AMH is a hormone produced by the developing follicles in the ovaries that is often used to determine the number of eggs remaining in the ovaries.
Antral follicle count (AFC) — AFC provides an estimate of the number of small follicles in the ovaries, which have the potential to develop into mature eggs. The measurement of antral follicle count involves a transvaginal ultrasound.
Follicle-stimulating hormone (FSH) and Estradiol (an estrogen) — Bloodwork indicating elevated FSH levels along with elevated estradiol levels can indicate poor ovarian reserve, as this may suggest that the ovaries are working harder to produce mature follicles and eggs.
“Your hormonal blood work is done at a specific time in your cycle, typically days 2-5, to let us know how the brain and ovaries are talking to each other — this is a more functional look at reserve,” says Dr. Ryniec.
Still, it's important to reiterate that age, in addition to AMH, AFC, and other hormone levels, is the most critical determinant of ovarian reserve and overall fertility potential.
Can antral follicle count help predict IVF success?
“Yes,” says Dr. Ryniec. “Since the success of IVF treatment is largely dependent on retrieving many eggs — compared to the one egg typically ovulated without a medicated cycle — ovarian reserve plays a major role in predicting success.”
In short, women with a higher ovarian reserve are expected to do better in a single IVF cycle because they are likely to retrieve more eggs. On the other hand, women with a low ovarian reserve tend to have a difficult time responding to IVF meds or may need to do multiple cycles in order to achieve the same success.
If you're doing IVF, the Alife app can help you keep an accurate record of your test results, get medication alerts and appointment reminders, and view next steps all in one place, so you can easily compare all of your past and present IVF information at once — including antral follicle count and size.
Antral follicle count by age
So, now we know that antral follicle count declines with age, but how many follicles are considered "normal" based on age?
“A normal antral follicle count is considered to be 3 to 8 per ovary, or realistically over around 10 follicles total. However, this is largely age-related and in a young healthy patient even though 10 is technically normal, this would seem low compared to most peers,” says Dr. Ryniec.
Here's a helpful breakdown:
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Age 25 to 34, AFC from 10 to 13
Age 35 to 40, AFC from 10 to 8
Age 41 to 46, AFC from 7 to 5
If your numbers are higher or lower than expected according to your age, it does not necessarily mean that you are super fertile or particularly low on fertility potential.
There may also be extenuating factors affecting your AFC. For instance, in some cases, a high AFC can be a result of polycystic ovarian syndrome (PCOS). Likewise, a low antral follicle count could indicate that you have premature ovarian failure and may not respond well to fertility meds.
As always, your team of healthcare providers will be able to properly determine your ovarian reserve and proceed with the best recommendation for treatment.
While it may sound daunting to hear that your ovarian reserve is constantly decreasing, understanding how your antral follicle count, in combination with other markers, can affect your chances of getting pregnant can bring you some much-needed clarity. Whether you're in the process of deciding whether to have your ovarian reserve tested, freeze your eggs to preserve your fertility, or use this information to move forward with IVF at the recommendation of your doctor, knowledge is power!