Fertility can feel like a puzzle, but advancements in medical science have empowered us with many tools to understand it better. One such tool is the antral follicle count (AFC)—a simple yet crucial test that gives insights into a female’s ovarian reserve. It provides clarity whether you are planning a pregnancy, thinking of IVF or just want to track your reproductive health.
Curious to know how an AFC test can help? Let’s understand in detail.
What are Antral Follicles?
An antral follicle is a tiny fluid-filled sac inside the ovary. A single ovary contains multiple follicles through which eggs are released each month during menstruation.
During ovulation, antral follicles are instrumental in maturing and releasing eggs at the optimal time. Many antral follicles participate in this process each menstrual cycle, but typically only one follicle successfully ovulates an egg. Occasionally, multiple mature eggs are released, increasing the likelihood of conceiving twins.
After ovulation is successfully done, the antral follicle turns into a corpus luteum (temporary organ in the ovary). Each antral follicle has a cavity inside it, referred to as an antrum. The size of the antrum determines the overall size of the antral follicle. An antral follicle around 1-2 mm in diameter can be easily seen and counted during the ultrasound.
What is Antral Follicle Count?
- Antral follicles are small, fluid-filled sacs in a woman’s ovaries where immature eggs are stored.
- The antral follicle count refers to the number of these follicles in an ovary.
- A transvaginal ultrasound is performed to check these follicles at the start of the menstrual cycle.
- The follicle count is an important measure that helps the doctors analyze the ovarian reserve, which is crucial for fertility.
How is the Antral Follicle Count Test Performed?
- The AFC test is a simple procedure that is performed using a transvaginal ultrasound.
- A small ultrasound probe is inserted into the vagina which provides a clear image of the ovaries.
- The number of antral follicles in both ovaries is calculated to determine the total antral follicle count.
What is the Right Time to Check Antral Follicle Count?
The best time to check antral follicle count is between day 2 and day 3 of your menstrual cycle. This is when the accurate count of follicles can be measured as they are in their resting phase (when they are small, fluid-filled sacs containing immature eggs).
What is a Normal Antral Follicle Count?
A normal AFC count varies by age and individual factors. However, here’s a general guideline:
- Day 2 or Day 3 AFC:
- Normal range: 6-10 follicles per ovary
- Low reserve: Less than 5 follicles
- High reserve (often seen in PCOS): More than 12 follicles per ovary
- Average Antral Follicle Count by Age:
- 20s-early 30s: 15-30 follicles
- Mid-30s: 10-20 follicles
- 40+: Below 10 follicles
Your normal antral follicle count can provide insight into your fertility potential, but it’s just one piece of the puzzle. Hormone levels, egg quality, and overall health also play a role.
How Much Antral Follicle Count (AFC) is Good for Pregnancy?
Unfortunately, there is no exact AFC for pregnancy. However, according to the experts and studies, the normal antral follicle count is considered when each of your ovaries has 5-10 antral follicles with approximately 2-10 mm in diameter.
You can also refer to the below table to understand different AFC reserve levels and what they indicate:
| Antral Follicle Count (AFC) | Result (Per Ovary) |
| Normal Reserve | 5-10 antral follicles per ovary |
| Low Reserve | <5 antral follicles per ovary |
| High Reserve | >10 antral follicles per ovary |
| Polycystic Ovaries | >13 enlarged antral follicles per ovary |
How is Antral Follicle Count Related to Age?
A woman’s fertility decreases as she ages, which also affects her follicle count. Refer to the table below to assess the antral follicle count range categorized by age, covering both ovaries:
| Age | AFC (For Both Ovaries) |
| 20-24 Years | 15 -30 |
| 25 – 34 Years | >12-25 |
| 35 – 40 Years | <8-15 |
| 41 – 46 Years | Pre-menopausal stage 4-10 |
How to Increase Antral Follicle Count?
While genetics largely determine ovarian reserve, some lifestyle changes may help support ovarian health:
| Lifestyle Change | How Can It Help? |
| Take a Balanced Diet | A diet rich in antioxidants, omega-3 fatty acids and whole foods can boost ovarian function. |
| Vitamin D | Vitamin D is considered good for ovarian health. Getting sunlight or supplements can help if you have vitamin D deficiency. |
| Manage Stress | Prolonged stress has a direct impact on hormonal levels. Yoga, meditation or pursuing a hobby can help manage stress. |
| Maintain a Healthy Weight | Being underweight or overweight can impact your antral follicle count and overall fertility. Therefore, maintain a healthy weight. |
| Supplements | CoQ10, DHEA and omega-3s may support ovarian health but do not take them without consulting your doctor. |
Antral Follicle Count & PCOS
- In women with PCOS (Polycystic Ovary Syndrome), the number of antral follicles is frequently higher. This is due to the large number of tiny immature follicles in their ovaries.
- Despite its apparent benefit, a high AFC count does not always translate into increased fertility.
- Even with more follicles, hormonal imbalance in PCOS can prevent ovulation which means the follicles are not regularly releasing mature eggs.
- Anovulation or the absence of ovulation, irregular cycles and trouble conceiving naturally can happen if ovaries are not releasing mature eggs.
Antral Follicle Count & IVF
- AFC is an important factor in IVF success because it helps predict the response of ovaries to stimulation medications.
- High Antral Follicle Count: It often means a better response to ovarian stimulation, leading to more eggs retrieved for fertilisation. However, if AFC is too high, as seen in some PCOS cases, there is a risk of Ovarian Hyperstimulation Syndrome (OHSS), which requires careful monitoring.
- Low Antral Follicle Count: It may indicate a low ovarian reserve which means fewer eggs are available and treatment protocols may need to be adjusted.
Does Low AFC Reserve Mean Infertility?
A low reserve of antral follicle count does not automatically indicate infertility. An antral follicle count just predicts the likeliness of a woman getting pregnant. With an early diagnosis of a diminished ovarian reserve and the fertility expert guidance for correct treatments, including lifestyle changes, you can improve your fertility and chances of successful conceiving.
Takeaway:
While Knowing about AFC count can help you and your doctor make informed decisions. It gives a clear picture of your ovarian reserve which is crucial for any fertility treatment including IVF. You might also find this IVF success rate guide helpful in navigating your fertility journey.
