Antral Follicle Count (AFC) testing is a valuable part of understanding fertility. It assesses the “ovarian reserve”—or egg supply—of a woman’s ovaries, providing insights into fertility potential.
Antral follicles are tiny fluid-filled sacs within the ovaries, each containing an immature egg. Think of them as “egg holders.” Every month, a few of these follicles grow, and some may mature and release an egg, which could be fertilized if sperm is present. Antral follicles give us an idea of how many eggs a woman has remaining.
What is Antral Follicle Count (AFC) Testing?
AFC testing is a way to count the number of these antral follicles in each ovary, providing an estimate of your “ovarian reserve”—or the number of eggs available for potential fertilization. AFC is especially useful for women planning fertility treatments like IVF or those who want to understand more about their reproductive health.
An ultrasound machine is used to view your ovaries. The machine uses reflected sound to create images of internal body organs like the ovaries. The procedure is painless.
Why Is Antral Follicle Count (AFC) Testing Important?
Understanding Ovarian Reserve
Ovarian reserve is the number of eggs a woman has left in her ovaries. AFC is a measure of this reserve, as it directly shows the number of antral follicles.
Example: A woman with an AFC of 15–20 follicles is generally considered to have a good ovarian reserve, especially if she’s in her 20s or early 30s. Fewer follicles suggest a smaller egg supply, which could affect fertility.
Planning Fertility Treatments
AFC results help doctors tailor fertility treatments, especially IVF. For instance, the AFC count helps doctors decide on the dosage of medication needed to stimulate egg production.
Antral Follicle Count (AFC) and Ovarian Response
It’s important to know that Antral Follicle Count (AFC test) also informs doctors about potential ovarian response to medications. This ensures that you are given the right dose of medicines to prevent either a poor or hyper response.
How is Antral Follicle Count (AFC) Testing Done?
Understanding Ultrasound
Ultrasound is a safe, painless imaging technique that uses sound waves to create pictures of the inside of your body. In AFC testing, an ultrasound machine sends sound waves that bounce off structures in the ovaries, producing a clear image that shows the antral follicles as small dark circles.
The Antral Follicle Count (AFC) Test Process
AFC testing is done with a specific type of ultrasound called a transvaginal ultrasound, which is commonly used in gynecology and fertility testing. Here’s what you can expect:
Timing: The test is usually done on day 2 or 3 of your menstrual cycle when hormone levels are steady and provide the most accurate AFC count.
Procedure: A small ultrasound probe is gently inserted into the vagina, allowing the doctor to get a close view of the ovaries.
Counting the Follicles: The doctor or technician counts the number of visible antral follicles in each ovary, which appears as small black circles on the ultrasound screen.
Preparation Tips
AFC testing generally doesn’t require special preparation other than tracking day of your cycles as the test needs to be done on day 2 or day 3 of your cycle. If you have irregular cycles or if your cycles are difficult to track, your doctor may put you on some medications to time the test appropriately.
How Antral Follicle Count (AFC) Changes with Age
The number of antral follicles naturally declines with age, just as the total egg supply does. Women are born with a set number of eggs, and as they age, the number of eggs (and antral follicles) decreases. This gradual decline is part of the natural aging process.
Typical Changes Over Time
In Your 20s: Women in their 20s often have a higher AFC, around 15–25 follicles, reflecting a strong ovarian reserve and a good potential egg supply.
In Your 30s: Women in their early 30s may still have a good reserve, often between 10–20 follicles. By the late 30s, this count may begin to drop to 5–10 follicles, as fertility typically declines more noticeably.
In Your 40s: Most women in their 40s will have a lower AFC, often fewer than 5 follicles. A lower count reflects a smaller ovarian reserve and can make natural conception more challenging.
Example: A 25-year-old woman with an AFC of 18 would have a strong ovarian reserve. By contrast, a 40-year-old woman with an AFC of 3 has a reduced reserve, which may affect her fertility options. There would be a good chance of getting 15-18 oocytes in the younger lady with higher AFC as compared to 3 or fewer oocytes in the older lady on an IVF cycle. Higher the number of oocytes retrieved greater the chances of a pregnancy resulting to a live birth.
Understanding Your Antral Follicle Count (AFC) Results
What’s a Normal Antral Follicle Count (AFC)?
A normal AFC varies by age. Generally, women in their 20s and early 30s have an AFC of around 10–20 follicles per ovary. This count tends to decrease with age, reflecting the natural reduction in ovarian reserve.
Example: If a 30-year-old has an AFC of 15, this suggests a healthy ovarian reserve for her age.
High Antral Follicle Count (AFC)
A high AFC, usually over 25 follicles, may indicate polycystic ovary syndrome (PCOS), a condition where the ovaries produce more follicles than usual, leading to potential fertility challenges and specific treatment needs.
Low Antral Follicle Count (AFC)
A low AFC, often fewer than 5 follicles, suggests a reduced/poor ovarian reserve, which could affect fertility. This is common in older women or those with specific health conditions.
Comparing AFC with Other Fertility Tests
AFC vs. Anti-Müllerian Hormone (AMH) Testing
AMH is another blood test for ovarian reserve, measuring a hormone related to ovarian activity. Together, AMH and AFC provide a comprehensive view of ovarian reserve. (The dotted red lines in the figure below demonstrate AMH<0.94ng/mL cuttoff for poor reserve (left) and 3.2ng/mL cutoff suggestive of PCOS (right))
AFC and Follicle Stimulating Hormone (FSH)
FSH is a hormone blood test used to evaluate ovarian function, though it’s less direct than AFC. Doctors often use AFC, AMH, and FSH tests together for a complete fertility assessment.
Using AFC in Fertility Treatments
Role of Antral Follicle Count (AFC) in IVF
AFC helps doctors predict the number of eggs and the response to medication in IVF.
Example: If your AFC is low, the doctor may use a higher dose of medication to stimulate more follicles. If your AFC is high, a lower dose might be used to prevent overstimulation. If you have low AFC a doctor may advice you on undergoing more than one IVF cycle to obtain a higher number of embryos to increase your chances of pregnancy.
AFC and IVF Cycle Management
A low AFC can sometimes increase the chance of IVF cycle cancellation if not enough eggs are produced. Knowing your AFC helps doctors anticipate this risk and counsel you accordingly.
AFC and the Risk of Ovarian Hyperstimulation
A high AFC can increase the risk of ovarian hyperstimulation syndrome (OHSS), where the ovaries respond too strongly to medication. Doctors use this information to tailor your treatment plan and minimize risks.
Factors That Can Affect AFC
Lifestyle Factors
Lifestyle choices like smoking, body weight, and stress can impact AFC and overall reproductive health.
Example: Women who smoke may experience a faster decline in ovarian reserve, leading to a lower AFC over time.
Medical Conditions
Certain health conditions, such as polycystic ovary syndrome (PCOS) or endometriosis, can influence AFC. PCOS often leads to a higher AFC, while endometriosis or previous ovarian surgeries may reduce the follicle count.
Cost of AFC Testing in Bangalore
AFC testing in Bangalore typically costs between INR 1,200 and INR 5,000, though prices can vary depending on the clinic.
Choosing the Right Clinic for AFC Testing
When selecting a clinic, keep the following points in mind:
Doctor’s Expertise: Look for a fertility specialist or an experienced gynecologist who can perform the ultrasound.
Reporting: Ensure the clinic provides a clear and detailed report in writing.
Consistency: Check if the AFC result aligns with other indicators, such as AMH or FSH levels, for an accurate assessment.
At Kalpa Clinic, we offer reliable and affordable Antral Follicle Count (AFC) testing to help you understand your ovarian reserve and fertility health. Our AFC test, priced between Rs. 1200-1500, is conducted by Dr. Chaitra, an experienced fertility specialist using advanced ultrasound equipment to ensure accurate and comprehensive results. With a convenient appointment process and dedicated fertility professionals, Kalpa Clinic provides personalized care every step of the way. To schedule your AFC test and take the next step in your fertility journey, please contact us today to set up an appointment at a time that suits you.
Frequently Asked Questions About AFC Testing
When Is AFC Testing Done?
AFC testing is usually scheduled on day 2 or 3 of the menstrual cycle for the most accurate results.
Are There Alternatives to AFC for Ovarian Reserve?
Yes, AMH and day 2-3 FSH tests are common alternatives that also assess ovarian reserve.
How Does AFC Affect Medication Dosage?
A higher AFC may mean a lower medication dose, while a lower AFC might need a higher dose to stimulate follicles.
How Does Age Impact AFC?
AFC declines with age, reflecting the natural decrease in ovarian reserve, which affects fertility.
Is AFC testing painful?
No. AFC testing involves the same discomfort as a vaginal examination. The procedure is done using transvaginal ultrasound. It may be uncomfortable if you find vaginal examinations painful and have conditions such as vaginismus. Talk to your doctor in such conditions for alternatives.
What’s the Risk of Hyperstimulation with High AFC?
A high AFC can increase the risk of ovarian hyperstimulation syndrome, so treatments may be adjusted to prevent this.
