Antral follicle count

Two useful markers for ascertaining fertility are your ovarian reserve and AFC. The first refers to the number of eggs that are available for fertilization. AFC is the number of antral follicles present in the ovary on Day 3 using vaginal ultrasound scanning.

Ovarian Reserve and Antral Follicle Count

Your ovarian reserve refers to the number of eggs that you have available for fertilization. A high ovarian reserve usually indicates a good number of viable eggs present in your ovaries. A low ovarian reserve may indicate that you have fewer available eggs.

Along with using biochemical tests such as your FSH level, inhibin level and AMH level to assess ovarian function, we can use biophysical markers to test these too. These biophysical tests use ultrasound technology to image the ovaries and the follicles. The most useful test is called an antral follicle count (AFC) , in which the doctor counts the number of antral follicles (also referred to as resting follicles) present in the ovary on Day 3 using vaginal ultrasound scanning. Antral follicles are small follicles , usually about 2-8 mm in diameter. The number of antral follicles correlates well with ovarian response. A normal total antral count is between 15 and 30. If the count is less than 6, the prognosis is poor. You can read more about the antral follicle count and see ultrasound images of these at the website . The volume of the ovaries also correlates with ovarian response. The volume of each ovary is calculated using the formula (length x width x height x 0.5 ) and the normal ovarian volume of both ovaries combined is 10 ml. Women with small ovaries (volume of less than 4 ml) have a poor ovarian response.

If any one of the tests for ovarian reserve was truly accurate then it would eliminate the need for the others ! The fact that there are so many (FSH, oestradiol, AMH, antral follicle count, inhibin) suggests none of them are truly reliable. If one test were the right one then that is the one we'd all be given and it would tell us the answer!

Please do remember that doctors do not treat numbers - we treat patients, so don't obsess over just one number is isolation.

The final proof of the pudding is in the eating - and your response to superovulation is the best way of assessing your ovarian reserve. If you grow eggs well, then you should not worry about your numbers !

Need help in interpreting the results ?

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.