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antral follicle count (AFC). While it may sound complex, AFC is a simple yet powerful indicator of your ovarian reserve, in other words, your fertility potential.
In this blog, you’ll learn what antral follicles are, how they’re measured, what the numbers really mean, and how this information can guide you on your path to parenthood.
What Are Antral Follicles?
Within your ovaries are very small sacs called follicles. They consist of a layer filled with fluid and contain a young egg. During each menstrual cycle, hormones influence some of the follicles, making one of them ready to release an egg.Antral follicles are small, typically measuring 2–10 mm in size, and can be seen on an ultrasound because they have reached a detectable stage of development. Once they enter this phase, they are thought to react to hormones, which indicate whether your remaining eggs are high in number and healthy.
What Is an Antral Follicle Count?
Your AFC is the count of these visible follicles in your ovaries during your menstrual cycle, on days 2 through 5. Your specialist will do a transvaginal ultrasound to determine the number of follicles. A larger number of antral follicles may allow your body to produce more eggs in a single cycle.This figure estimates how fertile you are and plays a role in choosing the right approach for diagnosis and treatment in fertility planning.
Why Is Antral Follicle Count Important?
When you are trying to get pregnant, AFC can help you set realistic goals. Here’s why it's considered important:- It helps estimate ovarian reserve: The AFC approach is considered a reliable way to assess the number of eggs you still have. Many eggs mean you have more left to use, but a smaller number may indicate that fertility could be affected.
- It predicts response to fertility treatments: Your advanced fertility care clinic can help you approximate how your ovaries will respond if you have an in vitro fertilisation (IVF) treatment. Getting more eggs from more follicles often makes the IVF process more likely to work successfully.
- It assists in diagnosing reproductive conditions: A significantly high or low antral follicle count (AFC) can indicate underlying reproductive conditions. A high AFC may be a sign of polycystic ovary syndrome (PCOS), while a low AFC could suggest diminished ovarian reserve or early ovarian ageing.
- It helps with individualised treatment plans: Fertility is deeply personal, and so is its treatment. Your AFC can help your doctor customise your treatment plan, whether adjusting medication dosages or deciding which fertility approach best suits you.
How Is the AFC Test Done?
You don't need any special preparation for an AFC scan. The process is straightforward:- Timing: The scan is typically scheduled early in your menstrual cycle (days 2–5) when hormone levels are low, and follicles are easiest to count.
- Procedure: A transvaginal ultrasound is used. This means a small probe is inserted into the vagina to get a clear view of your ovaries.
- Duration: The scan usually takes about 10–15 minutes.
- Result: The technician or fertility specialist counts the number of antral follicles in each ovary and gives a total number.
What Do AFC Results Mean?
While interpretations can vary depending on your age and health, here’s a general breakdown:- 8–15 antral follicles: Considered a normal range, suggesting good ovarian reserve.
- More than 15 follicles: This could indicate PCOS or a high ovarian response.
- Fewer than 5 follicles: May signal diminished ovarian reserve, especially if you're over 35.
What Factors Affect Your Antral Follicle Count?
Several elements can influence your AFC. Understanding these can help you and your fertility specialist interpret your results more accurately:- Age: As you age, your antral follicle count naturally declines. This decrease tends to become more noticeable after your mid-30s.
- Genetics: Some individuals may have a lower or higher count due to genetic factors, regardless of age.
- Health Conditions: Conditions like endometriosis or autoimmune disorders may impact ovarian health and reduce follicle count.
- Lifestyle Factors
Smoking, chronic stress, and poor nutrition can negatively affect your reproductive hormones and, over time, your follicle health.
How Does AFC Fit Into Your Fertility Planning?
Think of your AFC as one piece of the fertility puzzle. On its own, it doesn't determine whether you can or can’t conceive. But combined with your medical history, hormonal tests, and ovulation patterns, it helps you and your healthcare provider make informed decisions.Whether you're exploring natural conception, timed intercourse, IUI, or IVF, your AFC can guide the conversation about what’s possible and what’s optimal for you.
When Should You Get an AFC Test?
If you're under 35 and have been trying to conceive for over a year, or over 35 and trying for six months, it might be time to undergo a fertility evaluation, including an AFC test. You may also consider it earlier if:- You have irregular periods.
- You’ve had surgery on your ovaries.
- You have a family history of early menopause.
- You’ve been diagnosed with PCOS or endometriosis.
What Happens If You Have a Low Count?
A low AFC may feel concerning, but it doesn’t necessarily mean you can’t conceive. Many individuals with lower counts still become pregnant, with or without assisted methods. In such cases, your doctor may suggest:- Trying sooner rather than later
- Exploring fertility preservation options like egg freezing
- Considering fertility treatments like IVF with personalised stimulation protocols
What If You Have a High Count?
A high AFC may sound positive, and often it is, but if it's extremely elevated, your doctor might look into possible conditions like PCOS. You may also be at higher risk of ovarian hyperstimulation syndrome (OHSS) during fertility treatment, and your treatment plan will be adjusted to reduce that risk.Planning for a baby is a journey, and knowledge is one of your greatest tools. Your antral follicle count offers a glimpse into your reproductive health, giving you a better understanding of where you stand and your options. It's not a standalone diagnosis but part of a broader picture that helps you move forward with clarity and confidence.
FAQs on Antral Follicle Count and Why it's Important for Fertility Planning
- Is AFC the same as AMH?
No, but they’re closely related. Antral follicle count (AFC) is a visual count of follicles via ultrasound, while Anti-Müllerian Hormone (AMH) is a blood test that estimates ovarian reserve based on hormone levels. Both are used together for a more complete assessment. - Can the AFC vary from cycle to cycle?
Yes, your AFC can fluctuate slightly from month to month, though it generally stays within a certain range. That’s why it’s typically measured early in your cycle for consistency.
