Antral Follicle Count

The eggs that the ovaries produce develop in fluid filled sacs called antral follicles. Every female produces a number of follicles each month, and this number varies from one person to another. The number of follicles produced in any cycle is central to the success of assisted reproduction treatments. 

Antral Follicle Count

Antral follicle count tells a lot about a person’s ability to become pregnant naturally. In a typical cycle, antral follicles will develop in groups, and only one reaches full maturity. 

When relying on assisted reproduction treatment, having more than one mature egg increases the chances of success, thus it is crucial for a person’s antral follicles to be viable. 

Be that as it may, there are factors that do affect the potential number and quality of follicles produced during treatment:

Age

Typically, the number of follicles that a female produces decreases with age, as does the quality of eggs produced. This gradually narrows a person’s chances of becoming pregnant naturally.

Health

A person’s health as a whole is considered using several markers which include lifestyle, Body Mass Index (BMI), their use of tobacco, drugs, and alcohol. These factors combined contribute to the overall health, as well as the quantity and quality of their antral follicles.

Medical History

Just as good health has an impact on antral follicles, so do current and past diseases and medical conditions.  Hypertension, periodontal disease, chlamydia, PolyCystic Ovary Syndrome (PCOS), and endometriosis all diminish the quantity, as well as the quality of antral follicles. If someone has undergone chemotherapy or radiation treatment, it could cause them to become infertile altogether.

The Antral Follicle Count (AFC) Test

An AFC test is what a professional healthcare provider uses to get an estimate of the number of oocytes available in a person‘s ovarian reserve, and know how it compares to normal ranges. 

An AFC test is done using a transvaginal ultrasound which captures images of the ovaries. These images are sent to a specialist for interpretation, which in turn helps the healthcare provider to determine the most suitable assisted reproduction treatment for that individual.

Normal Vs. Abnormal AFC

When it comes to numbers, studies have shown that by the time someone reaches 37 years of age, the production of antral follicles declines by five percent annually, and thereafter, this decline more than doubles.

It has also been observed that people who already have a higher number of antral follicles to begin with, tend to produce a higher number of eggs during ovarian stimulation in assisted reproduction treatments.

Overall, the number of antral follicles produced naturally in the ovaries, by age, are shown below:

Follicles and Menstruation

Antral follicles begin their development in what is known as the follicular phase of a menstrual cycle. This phase starts as soon as menstruation ends and it lasts about two weeks at which point a mature egg is released from one of the follicles.

When a mature egg is released, the phase is known as ovulation and lasts for about a day or two. This phase occurs about two weeks before a period, and it is during this phase that an egg can be fertilized leading to pregnancy. 

The exact moment that a follicle matures and gets released is unknown and it is possible to become pregnant outside of the ovulation window.

Follicles in Fertility Treatments

Ovaries are stimulated using hormone injections and oral medications so that they develop multiple follicles to maturity. Having more than one mature egg increases the chances of a person becoming pregnant.

Intrauterine Insemination (IUI)

IUI treatments only require one mature follicle. However sometimes due to ovarian stimulation, more than one follicle could mature. As a result, an additional AFC test may be done before the IUI treatment begins.

If there are multiple mature follicles resulting from ovarian stimulation, it could result in multiple pregnancies. With IUI, if there are more than three mature follicles, typically, the procedure will be cancelled to prevent any risks during pregnancy. 

In Vitro Fertilization (IVF)

With IVF, AFC test results determine how the hormonal phase of the treatment will proceed. Typically, 10 - 15 follicles are required per round of treatment, and stimulating multiple follicles produces a larger number of eggs. 

To Conclude

The production of antral follicles determines a person’s fertility, but a low AFC is not an indicator of whether a person can become pregnant or not. What matters more is the health of the follicles themselves.  

If you want to know more about your antral follicles, or have any queries regarding your reproductive health, contact us at Ivy Fertility. Our team of professionals is available to support you in your family building journey with compassion.

Frequently Asked Questions (FAQs)

Is IVF better than IUI?

A professional healthcare provider can help you determine which treatment is best for you after they do consultation and run some tests.

Why is my AFC low?

There are many factors that affect an AFC result. A healthcare provider can explain to you which ones may have affected your AFC result. 

Can I increase my AFC?

No. AFC is unique to each individual. What can be improved is the quality and health of the eggs produced. Speak to your healthcare provider about the different things you can do to improve the quality of your eggs.