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The antral follicle count

Mr Amit Shah ,Mr Anil Gudi &Prof Roy Homburg

Advancing female age is probably the single most important factor influencing fertility potential. From the age of about 35 years onwards, there is a steady downward trend in fertility capacity and this is probably a reflection of the declining number of eggs remaining and biological aging. As a result, from the mid-thirties onwards, fertility potential decreases considerably. Advancing female age not only affects natural conception but also the results of fertility treatments. It is therefore important to know the so-called ovarian reserve or, more importantly, the number of eggs in their follicles (antral follicles) that are available for stimulation at the beginning of a cycle with the potential to ovulate in that cycle. This number directly reflects what will be the response to stimulation of the ovaries with medications and indirectly reflects the chances of pregnancy.

With the improvement in technology, the number of these antral follicles that are present at the beginning of the cycle can now be fairly accurately counted by vaginal ultrasound examination. The sum of these follicles in the ovaries can indicate what will be the response to treatment involving stimulation of the ovaries, particularly for the purpose of in-vitro fertilization (IVF), and allow the planning of the treatment doses to be used. For example, an antral follicle count of less than five usually indicates a low ovarian reserve and the need for relatively high doses of medication in order to produce a reasonable number of eggs for IVF. An antral follicle count of greater than 10, seen in such conditions as polycystic ovary syndrome, indicates a very good chance of harvesting a good number of eggs and usually demands a moderate dose of stimulating medications only. As a general rule, the more eggs that can be picked up during an IVF cycle, the better the chance of a pregnancy. Conversely, for “poor responders” the prognosis for pregnancy is not good. This is the reason that the antral follicle count can give a rough guide to the chances of success of treatment. It is thought to do this with approximately the same accuracy as the blood test for the level of anti-Mullerian hormone (AMH).

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