What is Antral Follicle Count (AFC)?

The pool of eggs in a woman decreases in size as she ages. With the onset of the 30s, a woman’s fertility starts to decline. Certain lifestyle habits like excessive drinking/smoking, lack of exercise, etc., also contribute to the decline of fertility. Post 35 years of age, women have a steadier decline in fertility.

If you are also approaching 30 years of age or want to get pregnant, you might want to know about your ovarian reserve in more detail. This will help you make a more informed decision regarding your pregnancy timeline. It will also determine if you need any fertility treatment or not.

You can get an antral follicle count done to measure your ovarian reserve. It is a very simple test and will be done in less than 30 minutes.

What are Antral Follicles? 

An antral follicle is a tiny fluid-filled sac inside the ovary. The ovaries contain the eggs released from the body every month during menstruation.

The antral follicles play a huge role in maturing the egg and releasing them at the right time during ovulation. Numerous antral follicles work on maturing the eggs each menstrual cycle; however, out of all, only one can ovulate the egg successfully. In rare cases, more than one mature egg is released, increasing the probability of twins.

After ovulation is successfully done, the antral follicle turns into a corpus luteum.

Each antral follicle has a cavity inside it, referred to as an antrum. The follicular fluid accumulated inside the 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? 

An antral follicle count measures the number of antral follicles in the ovary. The count must be done during an ongoing menstrual cycle, specifically between the second day and the fourth day. A transvaginal ultrasound is done to measure how many antral follicles are there.

An antral follicle count not only determines the status of the ovarian reserve but also provides information like whether you have primary ovarian insufficiency and other conditions like polycystic ovarian syndrome.

Additionally, with an antral follicle count, your doctor will also be able to determine your likelihood of conceiving a child as compared to other women of your age.

What is a normal antral follicle count? 

If each of your ovaries has 5-10 antral follicles approximately 2-10 mm in diameter, you are considered to have a normal antral follicle count.

Three results can be determined during an antral follicle count: low reserve, high reserve, and polycystic ovaries.

– Low Reserve

When there are less than five antral follicles per ovary, it is referred to as low reserve.

– High Reserve 

When there are more than ten antral follicles per ovary, it is referred to as high reserve.

– Polycystic Ovaries 

When there are more than 13 enlarged antral follicles per ovary, they are referred to as polycystic ovaries.

How is antral follicle count performed? 

The antral follicle count can be determined using a transvaginal ultrasound. It might sound scary, but do not worry. It can be performed easily and quickly by a health care professional.

During the test, a transducer is pushed into your vaginal opening. The doctor will use a condom and lubrication to cover the transducer for your safety and comfort. The transducer then produces ultrasound waves which generate internal scans. These scans are then read carefully to determine the number of antral follicles in your ovaries.

During the transvaginal ultrasound, its pictures would also be generated on the monitor, which helps the doctor determine where to move the wand and properly cover both ovaries.

An internal transvaginal ultrasound is preferred for this test instead of an external ultrasound, as the external ultrasound cannot produce clear scans. Unclear and blurry scans make it difficult for the doctor to give an accurate result.

Antral follicle count and age 

A woman’s fertility begins to decline with age. The follicle count also begins to drop as a woman gets older. When a doctor determines the result of your follicle count, he/she will also keep your age in mind.

– 25 to 34 Years 

15 is also considered a normal antral follicle count for this age group. Anything less than 5 is considered low, whereas anything more than 15 is high.

– 35 to 40 Years 

For this age group, an antral follicle count of 9 can be considered normal. Anything less than 3 is low, whereas more than 12 is considered high.

– 41 to 46 Years 

At this age group, a woman starts approaching menopause slowly. During this time, fertility is at the least. An antral follicle count of 4 is also considered normal at this age. Anything less than 3 is a low reserve, whereas anything more than 10 is a high reserve.

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 correct treatments and some lifestyle changes, the situation can be rectified.

That is why it is recommended to get tested for a diminished ovarian reserve as soon as possible. An early diagnosis will highly improve the chances of getting pregnant and conceiving.

Supplements are one way to treat a diminished ovarian reserve. Supplements with mild androgen are introduced into the body to increase the antral follicle count and improve fertility.

In vitro fertilization (IVF) and donor eggs are one way to conceive if a low antral follicle count highly affects your fertility.

Conclusion

Even if you are not planning to conceive, we recommend you get an antral follicle count done to gather accurate information for your future. Additionally, the antral follicle count will tell you the status of your ovarian reserve and other conditions, if any, like PCOD/PCOS.

Apart from the quantity of the eggs, an antral follicle count will also determine the quality of your eggs.

Now, if you are thinking about a place where you can get an antral follicle count performed, we can help you out. Visit Birla Fertility and IVF right away or book an appointment with Dr Souren Bhattacharjee Their highly skilled doctors and cutting-edge technology will allow you to make informed pregnancy plans.

FAQs:

1. What is a normal antral follicle count?

If your ovaries have somewhere between 5-10 antral follicles, then you have a normal ovarian reserve. However, remember that the normal range of antral follicles varies with factors like age and medical conditions.

2. What is a normal antral follicle count by age?

The range of normal antral follicle count reduces by age. For women between 25 to 34 years, the normal antral follicle count is between nine to twelve. For 35 to 40 years, it is around five to nine, whereas, for 41 to 46 years, less than five is also considered normal.

3. How many follicles in each ovary are normal?

If each of your ovaries has an antral follicle count between 5 to 10 then that is considered a normal antral follicle count.