Dr. Diana Rangaves, PharmD

Ovarian Reserve Testing: What is a good Antral Follicle Count for IVF?

For an IVF treatment, fertilization requires multiple antral follicles. Studies show that an AFC above 6 is suitable for treatment. Studies recommend the treatment as a last resort after others have failed.

What Are Antral Follicles?

Antral follicles, also called resting follicles, are tiny sacs of about 2-10mm in diameter and sometimes more. The follicles are invisible to the naked eye and are seen, counted, and measured with ultrasound.

Primordial follicle development

Women are born with ovaries with a lifetime supply of eggs that can be fertilized in a woman’s lifetime. As women grow old, 99% of the eggs diminish in a process known as atresia. An antral follicle is the last stage of primordial follicle development. An antral follicle count in IVF is critical because the treatment needs multiple follicles to mature for fertilization.

Normal antral follicle count

There is no perfect answer to the question of what is a good antral follicle number. Eggs drop in number and quality as women age. This is why fertility reduces as women age. Below is a typical antral follicle count (AFC).

  • Between 25-34 years, an average of 15 AFC
  • Between 35 -40 years, an average of 9 AFC
  • Between 41- 46 years, an average of 4 AFC

A high AFC count does not necessarily mean extra fertility. High AFC could indicate a polycystic ovarian syndrome (PCOS) condition. A lower AFC count could also mean premature ovarian failure or simply a lack of response to fertility drugs.

Number of follicles needed for IVF cycle

Studies show that antral follicle count (AFC) determines the ovarian response to IVF better than the anti-mullerian hormone (AMH).

In an IVF treatment, the goal is to stimulate the ovaries to mature several follicles. Studies have shown that an acceptable amount is any number above 6. If less than that, a poorer response is anticipated and IVF cycle is expected to be canceled.

When IVF is done

IVF is done when there is fallopian tube damage, ovulation disorders, endometriosis, unexplained infertility uterine fibroids, and previous tubal sterilization. In addition, the treatment can be done for fertility preservation due to health conditions such as cancer.

Studies recommend trying other less invasive methods of treatment first before attempting IVF. Some of the recommended treatments include fertility drugs and intrauterine insemination.

Risks involved

IVF treatment risks include; multiple births, premature delivery, ovarian hyper stimulation syndrome, miscarriage, egg-retrieval procedure complications, birth defects, ectopic pregnancy. Studies also show that the medication involved could also cause cancer and stress.

IVF treatment as a last resort

An IVF treatment can be tried even after several fertility tests have failed. The treatment can also be done after a long period of trying to get pregnant. Health experts caution that IVF treatment is often stressful, and many people benefit from having a support system.