Follicles and Fertility
Friday, January 19, 2007
Carl M. Herbert, MD
My colleagues and I occasionally field questions from patients about what fertility physicians are looking for in conducting an antral follicle count. This is a fascinating topic and my colleague at Pacific Fertility Center, Isabelle Ryan, MD, has been kind enough to share her expertise on this issue.
Women are born with all of the eggs (oocytes) that they will ever have. This is a set number, which is determined before birth. This pool of eggs is never replenished. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (6-7 million); at birth this number decreases to about 2 million; and by puberty to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life.
There is a continuous process occurring in the ovaries, where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial, to preantral, to then antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in our ovaries and those that are candidates for selection and growth by fertility stimulation medications (gonadotropins).
When assessing one’s ovarian reserve (potential for a successful pregnancy), a number of parameters are evaluated. One of these is called the “antral follicle count” (AFC). An antral follicle count is typically done during the 2nd-4th days of menstrual flow, though it can probably be as accurately done during other times of the menstrual cycle. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. For those undergoing IVF, a similarly low AFC will be associated with a higher cancellation rate. As women approach their 40s, and as day-3 FSH results rise above 10 mIU/ml, this typically correlates with fewer eggs overall in our ovaries, and therefore a low AFC. Indirectly, a low AFC can correlate with diminished ovarian reserve.
In the same way that there can be monthly variability in day-3 FSH test results, there can be monthly variability in the AFC. More variability is observed in the AFC of young infertile women than in older women. However, overall a single AFC is still quite predictive of ovarian response under gonadotropin stimulation, and there is fairly good agreement between repeated AFC over consecutive cycles. In conclusion, doing an AFC is an adjunct to the day 3-FSH test to predict ovarian reserve and ovarian response to fertility medications.
4 Comments:
At Mon Feb 12, 11:25:00 PM 2007,
Anonymous said…
One thing that I would like to post is that as a patient at PFC, something has bothered me since starting this process of IVF. I understand that all of the Dr's see many patients everyday so this becomes routine to the Dr's and the staff. But the emotional toll and anxiety and stress that each patient feels is extraordinary. One thing that has been difficult for me is that I feel as if everything is cookie cutter and that each patient is not looked at personally to see what THEIR best course of action may be. I like my Dr at PFC personally but have felt that I'm rushed in and rushed out, by the nurses and Dr's. Besides the overwhelming emotional toll, I feel angry at the idea of having to pay SO MUCH MONEY and than be rushed in and out everytime I go to the clinic. We are paying huge amounts of money out of pocket! Each patient that comes to your office has been dealing with one of the toughest problems that they will face in their lifetime, and I think that each Dr., nurse and staff member needs to remember the investment both personally and finacially that is being made everytime someone walks through your front door.
At Thu Jun 28, 09:32:00 AM 2007,
Anonymous said…
I would agree with what anonymous has said. i am also undergoing IVF treatment in alberta and I too feel as if we are being rushed in and out. we have inccured a huge financial expense as to this treatment and we are still paying. so far it has cost us 17,000 for the treatments to date, not including travel and lodging. is it too much to ask for a little concideration and at least try answer all our questions that we may have to make this rollercoaster ride a little more personal instead of making it feel like its all about the money.
At Mon Jun 30, 12:28:00 PM 2008,
Anonymous said…
i think that IVF procedures are done all over the world and i am not convince with it becoz i done ivf 2years ago and it didnot work wid me, i am married for 10years and my husband has a son with another woman and becoz i have a problem on my fertility thats why i try the IVF procedure but it did not work with me also IVF procedure is very costly and its not a joke for anybody who really wish to have a baby, i am only 29 years old and i am thin, i get married when i was 19 and i think doing IVF is very popular for anybody allover the world, what is the most best thing to do when u really want to get pregnant without doing IVF, I hope somebody can give me some advice too.
At Mon Oct 13, 06:33:00 PM 2008,
Anonymous said…
I agree with all of you. I am 39 years old and have gone for 3 IuI's with no pregnancy. I wait long hours in the clinic and I have waited a year with many tests and no pregnancy results. I am emotionally very upset and don't understand why I am not getting pregnant. I feel rushed in the clinic as well. I know the nurses and doctors have a lot of work to do, but I just wish I had more answers. I will not give up but I never imagined I would ever go through this in my whole life. I feel all of your pain and I wish you all get pregnant soon. Hang in there and be hopeful every day.
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