What is Antral Follicle Count (AFC)?

by | May 13, 2023 | Fertility

What are Antral Follicles?

When it comes to female fertility, antral follicles play a crucial role. But what exactly are antral follicles? Well, these tiny, fluid-filled sacs found in the ovaries hold the key to a woman’s reproductive potential. Each antral follicle houses an immature egg, and its development and count are closely linked to a woman’s reproductive health. Let’s delve deeper into the world of antral follicles and understand their significance.

 

What is Antral Follicle Count (AFC)?

Antral follicle count (AFC) is a diagnostic test that provides valuable insights into a woman’s ovarian reserve. It helps determine the number of antral follicles present in her ovaries. The AFC test is typically conducted through ultrasound imaging, allowing healthcare providers to visualize and count the antral follicles accurately.

 

What is the Significance of Antral Follicle Count?

The antral follicle count serves as an essential indicator of a woman’s fertility potential. A higher AFC suggests a healthier ovarian reserve and a greater likelihood of successful conception. On the other hand, a lower AFC may indicate diminished ovarian reserve, which could affect a woman’s ability to conceive naturally.

It’s important to note that the AFC, along with other fertility assessments, helps doctors evaluate the response to ovarian stimulation during assisted reproductive techniques such as in vitro fertilization (IVF). By knowing the antral follicle count, healthcare professionals can adjust the treatment protocol accordingly, increasing the chances of a successful outcome.

 

How is the AFC Test Performed?

The antral follicle count test is a simple and non-invasive procedure that can be performed at a fertility clinic or a specialized ultrasound facility. Here’s what you can expect during the AFC test:

  • Preparation for the AFC Test: Before the test, your healthcare provider will guide you on any necessary preparations. These might include avoiding certain medications or scheduling the test on specific days of your menstrual cycle. It’s crucial to follow the instructions provided to ensure accurate results.
  • The AFC Test Procedure: During the AFC test, you will lie down on an examination table while a trained technician or sonographer performs the ultrasound. A small, handheld device called a transducer is gently moved over your abdomen, emitting sound waves that create images of your ovaries on a monitor. The technician will carefully count the visible antral follicles in each ovary, recording the results for further analysis. The entire procedure usually takes around 15 to 30 minutes and is generally painless, though you may experience slight discomfort due to pressure on the abdomen.
  • Interpreting the AFC Test Results: After the AFC test, a fertility specialist will review the results and discuss them with you. The number of antral follicles observed in the ultrasound images will be taken into consideration. The interpretation of these results will depend on various factors such as your age, medical history, and overall reproductive health.

If your AFC falls within the expected range for your age, it generally indicates a normal ovarian reserve. However, if the count is lower than expected, it may suggest a reduced ovarian reserve, requiring further evaluation and potential fertility treatments.

What Is A Normal Antral Follicle Count?

ovarian-reserve

ovarian-reserve

  1. Low Reserve: A low reserve is like a thin book with fewer chapters. Women with an antral follicle count of less than 7 are considered to have a low ovarian reserve. But remember, quality often trumps quantity. So, a lower count doesn’t necessarily close the book on a woman’s fertility journey.
  2. High Reserve: On the other hand, a high antral follicle count, usually above 25, is akin to a thick, voluminous tome. This could indicate a healthy ovarian reserve. But, just like a longer book isn’t always better, a higher count doesn’t always promise fertility success.
  3. Polycystic Ovaries: Polycystic ovaries are complicated manuscripts of the fertility world. They often have an antral follicle count of 12 or more per ovary, making them a unique case. But remember, every unique manuscript has its reader; likewise, every unique fertility situation has its solutions.

 

Normal Antral Follicle Count By Age:

Just like the age of a book can affect its condition, a woman’s age can impact her antral follicle count. Let’s flip through the pages of different age groups.

  • 25 to 34 Years: In women aged 25 to 34 years, the normal antral follicle count often ranges between 15 to 30. These ‘freshly printed books’ usually have a higher fertility potential.
  • 35 to 40 Years: For women between 35 to 40 years, the ‘moderately aged volumes’ of the fertility world, the normal count can vary widely but typically decreases with age, often ranging between 10 to 20.
  • 41 to 46 Years: Women aged 41 to 46, the ‘vintage editions,’ often have a lower antral follicle count, generally below 10. However, remember that every ‘vintage edition’ holds its unique charm and possibilities.

Also Read: What is a Normal FSH Level to Get Pregnant?

Does Low AFC Reserve Mean Infertility?

Just like one wrong turn doesn’t mean you’re lost in a labyrinth, a low AFC doesn’t necessarily equate to infertility. Yes, it’s true that a low AFC indicates a lower ovarian reserve. But does it shut the door on fertility? Not necessarily!

Remember, quality can often triumph over quantity. A lower AFC might mean fewer eggs, but it doesn’t comment on the quality of these eggs. So, if you’re navigating the labyrinth of low AFC, don’t lose hope. There are still possibilities for a successful pregnancy.

 

How To Increase Antral Follicle Count?

If your AFC is low, there are pathways that can help boost your ‘fertility terrain.’ Lifestyle modifications like maintaining a healthy weight, managing stress, quitting smoking, and moderating alcohol can help improve your overall fertility health.

Dietary changes, such as incorporating antioxidant-rich foods and staying hydrated, may also positively influence your AFC. So, enhancing your fertility terrain can be as simple as making mindful lifestyle and dietary choices.

 

AFC in PCOS:

Polycystic Ovary Syndrome (PCOS) is like a rocky terrain in the fertility labyrinth. Women with PCOS often have a higher AFC. This could indicate a large number of immature follicles that don’t ovulate properly.

While a high AFC in PCOS might seem daunting, remember, every rocky terrain can be navigated with the right equipment—in this case, proper medical guidance and treatment.

 

AFC vs AMH:

AFC and AMH (Anti-Mullerian Hormone) are like the twin markers in the fertility labyrinth. While AFC gauges the number of antral follicles visible via ultrasound, AMH measures a hormone that reflects the size of the ovarian reserve. While both provide insights into a woman’s fertility potential, they each have their strengths and limitations. For example, AFC might fluctuate with each cycle, while AMH provides a more stable marker. Yet, AFC can give a more immediate snapshot of the ovarian reserve. So, understanding both markers can help navigate the fertility terrain more effectively.

 

Antral Follicle Count and Radiology:

Think of radiology as the ‘X-ray vision’ in the world of fertility. Radiology, specifically ultrasound imaging, is used to count antral follicles, providing a window into a woman’s ovarian reserve.

During the early part of a woman’s menstrual cycle, usually between days 2 to 5, a transvaginal ultrasound is performed. This non-invasive procedure allows radiologists to visualize and count the antral follicles in both ovaries, providing a direct measure of the ovarian reserve.

 

Antral Follicle Count Per Ovary:

If ovaries were twin towers, the AFC per ovary would represent the floors in each tower. Each ‘floor’ or follicle holds the potential for egg development and ovulation.

A normal AFC per ovary varies but typically ranges from 6 to 10 follicles. However, remember, just like a tower’s strength doesn’t solely depend on its floors, a woman’s fertility doesn’t solely rest on her AFC.

 

Average Antral Follicle Count at 35:

The age of 35 often represents a crossroads in the world of fertility. So, what’s the average AFC at this junction? Typically, a woman around 35 may have an AFC of about 12 to 18.

But remember, this is an average. The AFC can differ widely among women, and it doesn’t define the complete fertility potential. Much like how every crossroad offers multiple paths, every AFC provides different insights into a woman’s unique fertility journey.

Also Read: AMH Blood Test: Normal Range, Level & Price

Conclusion

Navigating the intricate maze of fertility can seem daunting, but understanding key markers like the Antral Follicle Count (AFC) can make the journey much more navigable. From its role in assessing a woman’s ovarian reserve, the significance of the count per ovary, the average count at the age of 35, to the implications of a low AFC, each aspect of AFC is a crucial landmark in the fertility landscape.

Remember, while AFC is a valuable tool, it’s not the sole determinant of fertility. It’s a piece of the puzzle, an essential chapter in the fertility story, not the entire narrative. Each woman’s fertility journey is unique, and understanding her individual path is crucial.

So, as you traverse the journey of fertility, may your understanding of AFC and other fertility markers empower you and light your way. After all, the journey of fertility, much like any voyage of discovery, is about learning, understanding, and ultimately, about the marvel and miracle of life itself.

 

F.A.Q

Q: What is a normal antral follicle count?

A: Antral follicle count refers to the number of small, fluid-filled sacs (follicles) present in a woman’s ovaries during the early phase of her menstrual cycle. A normal antral follicle count typically ranges between 5 and 20.

Q: What is a normal antral follicle count by age?

A: The normal antral follicle count can vary based on a woman’s age. Generally, younger women tend to have a higher count than older women. In women under 35, a count of 15-20 is considered normal. For women between 35 and 40, a count of 10-15 is considered normal. Women over 40 may have a lower count, typically around 5-10.

Q: What should antral follicle count be to get pregnant?

A: Antral follicle count alone does not determine the ability to get pregnant. It provides an indication of a woman’s ovarian reserve, which is the quantity and quality of her eggs. However, there is no specific count required to achieve pregnancy. Other factors such as egg quality, sperm quality, and overall health also play important roles.

Q: What period is the antral follicle count?

A: Antral follicle count is typically performed early in a woman’s menstrual cycle, usually between days 2 and 5. This is when the follicles are still small and can be easily visualized via ultrasound.

Q: How many follicles for PCOS?

A: Polycystic ovary syndrome (PCOS) is a condition characterized by hormonal imbalances that can result in the presence of numerous small follicles in the ovaries. The number of follicles seen in PCOS can vary widely, but typically there are more than 20 antral follicles present in each ovary.

Q: What is a good AMH level to get pregnant?

A: Anti-Mullerian hormone (AMH) is a hormone produced by the developing follicles in a woman’s ovaries. It is used as an indicator of ovarian reserve. There is no specific AMH level that guarantees or prevents pregnancy. However, higher AMH levels are generally associated with a larger ovarian reserve and may indicate a higher likelihood of success with fertility treatments.

Q: How many antral follicles are in PCOS?

A: In polycystic ovary syndrome (PCOS), the number of antral follicles in the ovaries can be significantly higher compared to women without PCOS. It is common to see more than 20 antral follicles in each ovary in women with PCOS. However, the exact number can vary from person to person.

Q: How can I increase my antral follicle count?

A: It is not possible to directly increase your antral follicle count. Antral follicles are a reflection of your ovarian reserve, which is determined by factors such as genetics and age. However, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and managing stress, can promote overall reproductive health.

Q: What is a healthy follicle size?

A: In the context of fertility treatment, a healthy follicle size is typically considered to be around 18-20 millimeters in diameter. This size indicates that the follicle is mature and ready for ovulation.

Q: Is antral follicle count better than AMH?

A: Antral follicle count and anti-Mullerian hormone (AMH) are both important indicators of ovarian reserve, but they provide different information. Antral follicle count measures the number of small follicles present in the ovaries at a specific time, while AMH measures the hormone level associated with ovarian reserve. Both tests have their merits and are often used together to assess fertility potential.

Q: What is the normal follicle size on day 12?

A: On day 12 of the menstrual cycle, a normal follicle size can vary but is typically around 16-22 millimeters. This size indicates that the follicle is growing and nearing maturity.

Q: What is the best cycle day for antral follicle count?

A: The best cycle day for antral follicle count is typically between days 2 and 5 of the menstrual cycle. During this time, the follicles are still small and can be easily visualized via ultrasound.

Q: Can antral follicle count be done anytime?

A: No, antral follicle count is typically done early in the menstrual cycle, between days 2 and 5. This is because the follicles are in their early stages of development and can be accurately counted and measured during this time.

Q: How many eggs are in one follicle?

A: Typically, there is only one egg contained within each mature follicle. However, it is important to note that not all follicles will develop and release an egg during each menstrual cycle.

Q: How can I increase my follicle size naturally?

A: It is not possible to directly control or increase the size of follicles naturally. Follicle size is determined by the natural hormonal and physiological processes in the body. However, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and managing stress, can support overall reproductive health. It is best to consult with a healthcare provider for personalized advice on optimizing fertility.

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    Dr Mona Dahiya

    Dr Mona Dahiya

    IVF Specialist & Consultant

    Dr Mona Dahiya has performed over 5,000+ IVF cycles and is considered a global expert in IVF, ICSI, IUI and male fertility treatment. She is an eminent writer on Infertility Treatment and has over 100 Publications in both International and National Journals. Dr Mona Dahiya has immensely contributed to the field of infertility through her Research and articles.

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