What is Antral Follicle Count? AFC in Fertility

It’s possible to estimate the remaining eggs in your ovaries… 🥚

“Say whaaattt?!”

Yep — you heard that right.

As women, we have more than a million follicles in our reserve when we’re born.

As we age, and our menstrual cycle kicks in, groups and groups of follicles are recruited every month, with only one emerging with the egg of the month.

In the process, the rest of the follicles are martyrs. 😔

The rate at which this happens can vary.

And especially when you’re entering your 30s, it can start hitting the accelerator, impacting your fertility.

If you’re trying to conceive around that time, knowing your AFC can be helpful.

So, how exactly can AFC tell you where you stand, in terms of fertility and the number of eggs left in the basket? 🧺 

Let’s find out together. 👇

In this article: 📝

What is AFC?

AFC, or antral follicle count, is an ovarian reserve test that measures the number of antral follicles.

Antral follicles are fluid-filled sacs that house immature eggs. 🥚

As well as housing them, these follicles play a key role in helping the eggs grow, mature, and in the release of an egg during ovulation.

While there are millions of follicles in your ovaries, they’re mostly visible when they’re at the antral follicle stage — so, around a size of 2-10mm.

How long does It take for antral follicles to grow?

An antral follicle is basically the adult phase of a follicle.

On average, it takes approximately 10-14 days for follicles to reach maturity during a menstrual cycle.

During a menstrual cycle, the follicle starts out as small, and eventually grows and develops (along with the egg inside) into an antral follicle housing a mature egg.

How do you measure AFC?

AFC is measured using an ultrasound.

Each month, a set number of antral follicles are recruited in a race to grow the egg of the month. 🥇

Using a transvaginal ultrasound probe inserted in the vagina, it is possible to find out the number of follicles in each ovary.

Hats off to modern technology! 🎩

Now, because the probe is inserted via the vagina, the ultrasound waves are emitted internally, leading to a clearer picture of the ovaries.

Remember that follicles that are between the size of 2-10mm in diameter are considered.

This ultrasound is also usually conducted at the earlier stage of your menstrual cycle (around the 2nd and 3rd day) when the follicles are more prominent and measurable.

Why is antral follicle count taken on day 3?

AFC is often measured on day 3 of the menstrual cycle.

But, it can be done anytime between day 2-4.

This is because this is the duration where follicles are at a size of 2-6mm.

Now, that’s just the baby stage…

Follicles that are nearing the mature stage are usually at 7-9mm.

As we age, the 2-6mm follicles decline in number, but the 7-9mm ones remain constant.

That’s why measuring the former gives us a more accurate representation of the ovarian reserve.

What is a normal antral follicle count?

An AFC of 8-16 is generally considered normal.

But this largely depends on your age.

Some studies also mention how an AFC value of 10 (an average of both ovaries) can also be considered a healthy follicle count to conceive.

All the follicles between 2-10mm in each ovary are counted and averaged to get the AFC.

But hey, here’s the headline… 📰

Your AFC isn’t a direct indicator of pregnancy, but rather a rough idea of the eggs remaining in your ovaries.

Your AFC changes with age, too!

Normal antral follicle count by age

According to some studies, antral follicle counts have the highest association with age.

As you age, this is how your AFC might look like:

• 20-30 years: 10-20 follicles
  
• 30-40 years: 5-14 follicles
  
• 40 years or older: AFC <5

These numbers are not exhaustive, though.

It’s good to remember that other factors such as genetic conditions (like diminished ovarian reserve), injuries, or other individual factors may also affect AFC.

Normal antral follicle count per ovary

AFC is typically measured for each ovary separately, and the average value after adding up both is considered the total AFC.

Against your age, a normal antral follicle count per ovary can be:

• 20-30 years: 5-8 follicles per ovary
  
• 30-40 years: 4-7 follicles per ovary
  
• 40 years or older: 2-3 follicles per ovary

Also, it’s good to note that it’s fairly common for one ovary to have a slightly higher count than the other.

Can AFC change month to month? 🗓️

Yes, AFC can vary from month to month due to natural hormonal fluctuations.

But these changes usually aren’t too drastic.

Factors like stress, illness, or changes in lifestyle may influence these fluctuations.

But, given that the variation is very minimal, AFC is still used as a predictor of your ovarian reserve.

This is because, when coupled with AMH, it works to help understand your fertility potential.

Basically, it gives you a clearer picture of where you stand in your reproductive age!

Why is my antral follicle count low?

A low AFC is when the levels are <5-7 follicles.

This could happen when:

• You’re over 38 years old
  
• You have a genetic or an acquired condition, such as diminished ovarian reserve, that could lead to low AFC, sometimes even at a younger age
  
• You have a pelvic infection
  
• You’ve had ovarian surgery for ovarian cyst
  
• You’ve undergone chemotherapy

Hang on…

So, a low AFC doesn’t necessarily mean infertility?

It may make conception a little harder, or the doctor may let you know of the associated risks and challenges, but that doesn’t mean conception isn’t possible.

So even if your AFC is on the lower side, try not to worry.

After proper counseling from your healthcare provider, you should be able to understand your ovarian reserve better, and the steps that you can take when you’re TTC.

Can stress affect antral follicle count?

Some studies say that high levels of stress can lead to lower levels of AFC.

Stress over time due to your workplace, personal issues, or any other cause can affect the number of follicles in your ovaries.

But wait, how exactly?

Well, stress releases cortisol, which in turn reduces the amount of estrogen produced by the ovaries.

A reduction in estrogen levels leads to impaired egg development and even egg death.

Our advice?

Rest up, whenever needed!

Engaging in stress-reducing activities like meditation, journaling, yoga, or counseling may positively contribute to reproductive health.

🔍 Learn more: Can Stress Cause Infertility?

What happens if my antral follicle count is low?

We’re here to give you peace of mind…

Because it’s nothing to worry about.

Everyone’s antral follicle count declines with age.

If yours is low, it simply means that the number of follicles that are recruited every month to compete for the egg of the month is less.

This doesn’t mean that you can’t conceive naturally or through IVF.

At the most, a low antral follicle count can only affect you during IVF medication.

Your response may be less than the responses of women with higher AFC.

But whichever route you take, remember, one good quality egg is all we need, for conception. 🤰

Can you get pregnant naturally with low antral follicle count?

While low AFC may present challenges, yes, getting pregnant naturally with low AFC is possible! 👶

After all, getting pregnant naturally depends on the quality of the egg and requires one sperm and one egg.

Seeking advice from a fertility specialist can help you choose the best course of action for you.

Can you improve your antral follicle count?

Well, it’s a little tricky.

While it’s not possible to increase AFC directly, what you can work towards is adopting a healthy lifestyle, maintaining a balanced diet, and managing stress levels to positively impact your ovarian health.

For instance, you can:

• 🍏 Improve nutrition: Ensure you have a diet rich in antioxidants, vitamins, and minerals.
  
• 🏃‍♀️ Exercise: Engage in moderate exercise to promote overall well-being.
  
• 🚬 Avoid smoking and excessive alcohol: These habits can adversely affect fertility.
  
• 💪 Maintain a healthy BMI: Both underweight and overweight conditions can impact AFC.

Can antral follicles disappear?

Antral follicles do not disappear, but rather they decline over time.

This is, because, as you age, the number of eggs in your ovaries (and the follicles that house the eggs) also decreases.

But there’s also the rare case of the “vanishing follicles” 😶‍🌫️.

Studies have found that there are some very rare cases where the follicle expansion is so large, that the ovarian walls fail to tolerate it (mostly due to aging and the lack of strength in ovarian walls).

And this results in the release of the egg, and spontaneous disintegration of the follicles.

But don’t worry.

Surprising, yes they can disappear, but it’s very rare.

Do IVF meds increase follicle count?

Yes, medications used in IVF can help increase follicle account, but this only happens for the menstrual cycle that you are medicated for.

This is because IVF medication aims to increase the follicles recruited in one menstrual cycle to get as many eggs as possible for the IVF treatment. 🥚

After your IVF cycle, because of the lack of medication, your body resumes its natural cycle of recruiting fewer follicles and one mature egg each month.

What is a good antral follicle count before IVF?

An AFC of 8-16 is said to predict normal response to IVF.

Below 8 may be a bit challenging, and your ovaries may not respond that effectively to medication.

On the other hand, an AFC count above 16 requires monitoring too, as there may be chances of a hyper-response!

Is antral follicle count or AMH more important?

AFC and Anti-Mullerian Hormone Test (AMH) are both ovarian reserve tests that come with their own benefits.

AMH is considered more reliable, as it rarely fluctuates every month.

But AFC is considered to be a better predictor of ovarian response and is a more routine test compared to AMH.

The verdict?👩‍⚖️

What’s more important depends on your cause.

If you’re looking to understand your fertility levels when you’re trying to conceive, AMH may be a good predictor.

But if you’re starting an IVF cycle and want to monitor your response to the medications, AFC may be the better option for you.

Rather than either of them being more important than the other, both antral follicle count and AMH are necessary to provide an accurate picture of your ovarian reserve.

A final note on AFC

While your antral follicle count is a good predictor of the number of follicles that are recruited every month, it does not predict your ability to conceive naturally.

Your ability to conceive is still based on a lot of factors such as age, genetics, medical history, and so on.

AFC comes into the picture as an important parameter, when you’re trying to conceive, have barriers while doing so naturally, and are exploring assisted reproductive methods.

And if your AFC is on the low or the higher side, don’t worry — there are always methods and personalized protocols that can assist in this situation and in your efforts at conceiving.

We know, all this fertility and TTC talk can be a lot.

So if you want to talk with other women who get what you’re going through, we’re having the conversation on Peanut.

Join us — we know you’ll fit right in. ❤️