Seeing small dark circles on an ultrasound screen, or spotting “AFC” in your test results, can spark plenty of questions. The circles are follicles, and counting them is one of the most useful ways for your doctor to learn about your ovaries.
At Fertility Specialists of Texas (FST), our team uses your antral follicle count (AFC) as one piece of a bigger picture, helping us build a plan that fits you and your goals.
What Are the Follicles in Your Ovaries?
The follicles in your ovaries are small, fluid-filled sacs, and each one holds an immature egg. At the start of each menstrual cycle, a group of follicles begins to develop. In most cycles, one follicle matures and releases its egg at ovulation, and the rest of the group stops developing.
The number of follicles on each ovary decreases gradually over the years. Counting them gives your doctor a clearer view of your ovarian reserve, meaning the number of eggs your ovaries have remaining.
What Is an Antral Follicle?
An antral follicle is a small resting follicle, about 2 to 10 millimeters across, that your provider can see on ultrasound early in your cycle. Each antral follicle has the potential to develop further, so the number your provider sees offers a snapshot of how many eggs may respond in a given cycle.
How an Antral Follicle Count Is Done
Early in your cycle, your provider will perform a transvaginal ultrasound and count the small follicles in both ovaries. The scan will take only a few minutes and will feel similar to a routine pelvic exam. Our fertility testing for women includes an antral follicle count as part of a full evaluation.
According to the American Society for Reproductive Medicine (ASRM), your AFC is the total number of antral follicles in both ovaries seen during the early part of your cycle. ASRM notes that AFC stays consistent from cycle to cycle and is highly reliable in experienced centers, and our team performs AFC scans as a routine part of fertility testing.
How Many Follicles Should You Have in Each Ovary?
There’s no single right number of follicles in each ovary. Even a typical count varies with age and from person to person, and your doctor will interpret your count in the context of your full evaluation.
If your count is lower than expected, your ovarian reserve may be lower as well. Your doctor may use that information to guide your medication choices and the timing of your treatment.
If your count is higher than expected, it may be a sign of polycystic ovary syndrome, now also called polyendocrine metabolic ovarian syndrome (PCOS/PMOS). ASRM endorsed the new name to better reflect the condition’s hormonal and metabolic effects. A higher count may mean your team adjusts medication doses to help your ovaries respond safely, and FST offers dedicated PCOS/PMOS care.
What Your Antral Follicle Count Can and Can’t Tell You
Your AFC is a valuable tool for understanding your ovarian reserve and planning treatment. According to ASRM’s committee opinion, AFC is a strong predictor of how your ovaries will respond to fertility medications, including how many eggs may be retrieved during in vitro fertilization (IVF).
On its own, AFC is not a strong predictor of whether you can get pregnant. Your count is information that helps your team plan, and pregnancy depends on far more than one number.
AFC also measures egg quantity and does not measure egg quality, so your fertility specialist, also called a reproductive endocrinologist, will look at your count alongside your age, health history, and other test results.
Antral Follicle Count and AMH Work Together
Anti-Müllerian hormone (AMH) is a blood test that also reflects ovarian reserve, and ASRM considers AFC and AMH comparable measures. Our physicians at FST typically recommend both tests, since together your AFC and AMH testing results give a fuller picture and help your doctor choose medication doses and a treatment approach.
How FST Uses Your Results to Build Your Plan
Your doctor will review your AFC with the rest of your fertility evaluation and talk through what your results mean for your goals. Whether you hope to conceive soon, are considering IVF, or want to plan ahead, your plan will reflect your timeline and what feels right to you.
For anyone planning for the future, egg freezing is one option your doctor may discuss. Every path is a valid one, and our team will support the choice that fits
