Antral Follicle Count and Egg Freezing

Normal Antral Follicle Count by Age

Here’s the thing: AFC is just one piece of the puzzle. While a general guideline exists, individual variations are way more common. 

For instance, someone in their 20s may have a higher AFC, but if someone in the same age group has a low ovarian reserve due to genetic factors, they may have a lower AFC. Hence, variations based on heredity and overall health are to be factored in.

Here's a simplified chart that lets us know the average AFC ranges by age:

Source

How is AFC Measured?

Measuring your AFC is a relatively simple procedure. Compared to an AMH blood test, AFC is measured using a transvaginal ultrasound. 

During the scan, the sonographer uses a specialised probe inserted into the vagina to visualise your ovaries and count the visible antral follicles. 

Why this, you ask?

The probe emits ultrasound waves, which help obtain a clearer image of the ovaries. 

This typically takes less than 15 minutes and can be performed in a doctor's office or an ultrasound clinic.

It’s better to know beforehand that while this procedure may cause mild discomfort, it shouldn’t be painful. 

When is AFC usually measured?

The time at which AFC is measured has a lot to do with their size. 

An AFC test can be done at any point in your menstrual cycle, but it's often recommended during days 2-4 of your menstrual cycle.

Around this stage of the menstrual cycle, follicles are usually at a size of 3-10mm. Which, in a way, is at its immature stage 👶. Follicles which are nearing the mature stage, will be around 16-22mm.

As we age, the number of 3-10mm follicles decreases (due to age-related decline in the number of eggs), but the mature ones remain constant.

Hence, measuring your AFC on day 3 of your menstrual cycle (done most often!) or anytime between days 2-4 is a more accurate representation of your AFC.

Does Antral Follicle Count Change During the Cycle?

Yes, antral follicle count does vary within a single menstrual cycle. It also varies between back-to-back menstrual cycles. This variability is one of the reasons why it’s measured alongside AMH to understand our ovarian reserve better.

This variability is also why it’s recommended to measure it during days 2-4 of the menstrual cycle (early follicular phase) to avoid the confounding effects of a dominant follicle, cyst, or corpus luteum. 

Essentially, this timing ensures most follicles are in their antral stage and provides a clear count before selection and dominance changes later in the cycle.

Can I Increase my Antral Follicle Count?

There is no exact medication or method that can help increase antral follicle count. AFC typically declines with age and cannot be naturally increased, as the total pool of follicles is set before birth (aka, we are born with all the follicles we will ever have).

However, there are some cases where there can be a temporary increase in AFC, such as:

• If you’re taking hormonal contraception or any other medication: In cases such as long-term contraceptive usage, your AFC might appear lower than it normally would be. Post stopping and allowing your body to recover, you may see the levels increase.
• In very rare cases such as hypothalamic amenorrhea, synthetic LH is provided as a treatment startegy which can improve AMH and AFC.
• During an egg freezing cycle: Ovarian stimulation is used to recruit more follicles for that cycle, which can temporarily increase your AFC. However, this doesn’t reflect a permanent change in ovarian reserve.

AFC and Egg Freezing: What’s the connection? 

Egg freezing, also known as oocyte cryopreservation, is where your eggs are retrieved, frozen, and stored for future use. Along with an AMH test, doing an AFC test prior is crucial as it can help you understand these factors: 

Response to egg freezing cycle

AFC is a key determinant of how your follicles grow in response to medication given during egg freezing cycles. AFC even correlates with the number of eggs retrieved, making it an informative report for doctors to tailor stimulation protocols and medications accordingly.

Choosing the right protocol

Based on your AFC, your doctor can tailor the stimulation protocol for egg retrieval. This ensures you receive the optimal dosage of medications to stimulate your ovaries and maximise the number of mature eggs retrieved.

Determining the best timing

AFC can also help you decide the ideal time to freeze your eggs. Ideally, egg freezing should be done when your ovarian reserve is still good, offering a better chance of retrieving a sufficient number of healthy eggs.

📚Also read: How many eggs should I freeze by age?

Risk of OHSS (Ovarian Hyperstimulation Syndrome)

Taking an AFC test can act as a predictive tool prior to your egg-freezing cycle. Studies have shown how AFC levels of >24 can be a predictor of moderate to severe OHSS. This way, healthcare providers can be more vigilant of your response in the egg-freezing cycle and tailor protocols to reduce the risk of OHSS. 

What else does an AFC test tell you?

Besides the context of egg freezing, an AFC test can also provide insights into other aspects of your reproductive health, such as:

PCOS (Polycystic Ovary Syndrome): Women with PCOS often have an elevated AFC due to the presence of numerous small follicles. However, these follicles might not necessarily contain mature eggs.

Ovarian reserve: A low AFC can be an indicator of diminished ovarian reserve, suggesting a lower potential for spontaneous pregnancy or a lower response to fertility treatments like IVF.

I have low AFC, can I freeze my eggs? 

Yes, you can still freeze your eggs even with low AFC. However, it's essential to discuss your options with your doctor. They might suggest:

• Freezing at a younger age: If possible, consider freezing your eggs sooner when your AFC is likely to be higher.
• Utilising a different stimulation protocol: Your doctor might adjust the medication dosage or use different types of protocols for egg pooling, and so on, to optimise egg retrieval even with a lower AFC.
• Considering alternative options: Exploring options such as donor eggs might be an option based on your situation and preferences.

What does a high AFC mean?

Having a high AFC typically indicates a good ovarian reserve, with a higher chance of obtaining eggs and a good ovarian response. However, it's equally important to discuss this with your doctor, as it could also be associated with:

• Polycystic Ovary Syndrome (PCOS): Women with PCOS typically show a high AFC due to the presence of many small antral follicles. 
• Risk of Ovarian hyperstimulation syndrome (OHSS): This is a potential side effect of fertility medications, and your doctor might adjust the protocol to reduce exaggerated ovarian response or choose alternate options such as IVM (In Vitro Maturation) + egg freezing to minimise the risk of OHSS.

How much does an AFC test cost?

The cost of an AFC test can vary depending on factors like your location, insurance coverage, and the clinic.

Cost of an AFC Test in the UK and London:

The cost of an AFC test in the UK and London can range from £100 to £250 depending on the location and services included (consultation, report, etc.). Here is a breakdown:

Location: Costs can differ slightly between different regions in the UK.

Clinic: Costs can vary depending on the clinic offering the test. Additionally, follow-up consultations to understand the results of the AMH test also add on to the costs.

NHS coverage: Check with your GP or healthcare provider for guidance and potential referral options within the NHS You can also read our guide to check whether you’re eligible for egg freezing on the NHS. 

Insurance coverage: If you have private health insurance, it might cover the cost of the AFC test partially or fully. Always check with your insurance provider for specific coverage details.

Save on your Egg-Freezing Costs, with Amilis 

With all the humdrum around egg freezing, it can often come across as a luxury treatment or a pricey reproductive choice.

But we’re here to tell you that it doesn't have to be. 

At Amilis, we worked to identify the gaps and stages where we could make the procedure cost-effective while partnering with the best fertility clinics in the UK that provide egg freezing.

Here’s how:

• Book free consultations with some of the best egg-freezing clinics in the UK
• Free consultations with fertility specialists near you- based on your health concerns 
• Discounted egg-freezing packages across clinics in the UK

And if you’re just looking to know your fertility or reproductive health better, we’ve got you covered too 🫂

• Let’s start with fertility testing- We offer AMH testing at £180 or a full hormone panel test at £1130 (at half the price that clinics offer)with minimal to no wait times. Get tested at a nearby Randox clinic, at your schedule
• A personalised, free AMH report, and free 1-1 calls with the Amilis team to discuss next steps

And throughout, you’ll have Amilis experts (that’s us 👋) supporting you on your journey.

Figuring out where to get started? Book a free call, or take our personalised fertility quiz. 

We’re making egg-freezing more accessible and affordable, for women in the UK, one step at a time ♥️

Frequently asked questions

What’s the difference between an egg and an antral follicle?

Antral follicles are small, fluid-filled sacs that contain immature eggs. Eggs or oocytes are the cells that need antral follicles for nutrition, growth and development. These cells only part ways when a dominant follicle releases a mature egg. The egg moves towards the fallopian tube for fertilisation, and the dominant follicle turns into a hormone-producing structure called the corpus luteum.

How many follicles are normal in each ovary?

A normal follicle count largely depends on age, but is considered to be around 3-8 per ovary. Additionally, the antral follicle count takes into account the sum of follicles from each ovary. However, it’s important to remember that your AFC numbers are not a direct indicator of your fertility potential.

What do follicles look like on ultrasound?

Ovarian antral follicles can be seen and counted using a transvaginal ultrasound. The follicles look like black bubbles on the screen of the ultrasound machine. The machine can then be used to check the size of the follicles as well. 

How to increase antral follicle count?

There is no exact method or medication to help increase antral follicle count. While it declines as we age, there are some ways to “slow down” this natural decline or preserve the existing reserve. Taking antioxidant supplements such as selenium and vitamin E, eating a balanced diet, and reducing or abstaining from smoking, vaping, and drinking can help.

What are some supplements to increase antral follicle count?

There is some evidence that supplements like selenium and vitamin E may increase AMH and AFC in women with ovarian insufficiency, suggesting these antioxidants might have a positive effect in select groups. However, these results are preliminary, and large-scale studies are lacking.