Assessment of Ovarian Reserve (AFC)
Assessment of ovarian reserve (AFC – Antral Follicle Count) is a fundamental test in the evaluation of female fertility. Through this test, the ovarian reserve is assessed, meaning the number of eggs that remain in the ovaries and may potentially mature.
The AFC test provides valuable information both for women who are trying to conceive naturally and for those planning in vitro fertilization (IVF). It is one of the first diagnostic steps when there is difficulty conceiving or when the possibility of delaying motherhood is being considered.
What is ovarian reserve assessment?
Ovarian reserve refers to the quantity and, to some extent, the quality of the eggs available in the ovaries at a given point in time. As age increases, ovarian reserve naturally declines.
Ovarian reserve assessment is mainly performed through the Antral Follicle Count (AFC). This involves counting the small follicles (antral follicles) that are visible in the ovaries at the beginning of the cycle, using a transvaginal ultrasound scan.
These follicles represent the “pool” of eggs that may respond to hormonal stimulation, a factor that is especially important in planning fertility treatments.
How is the AFC test performed?
The AFC test is performed using a transvaginal ultrasound scan and is usually scheduled during the first days of the cycle (days 2–4 of the period). At that time, the small follicles are more easily visible and their count is more reliable.
In practical terms, what does the procedure include?
- The woman visits the clinic during the first days of her cycle.
- A vaginal ultrasound scan is performed, as in a standard gynecological examination.
- The physician records the number of small follicles (usually 2–10 mm) in each ovary.
- The total number from both ovaries constitutes the Antral Follicle Count (AFC).
The test takes only a few minutes and does not require any special preparation.
What is assessed during AFC measurement?
During ovarian reserve assessment, not only the number of follicles is recorded, but also the morphology of the ovaries, their size, and the uniformity of the ovarian tissue.
The AFC test is often combined with blood hormone testing, such as AMH (Anti-Müllerian Hormone), to provide a more complete picture of ovarian reserve.
The correct interpretation of the findings is not based exclusively on a single number, but also takes into account the woman’s age, medical history, and reproductive plans.
The role of AFC measurement in treatment planning
Assessment of ovarian reserve (AFC) is a key tool for the personalized planning of a reproductive strategy.
Based on the Antral Follicle Count, the physician can:
- estimate the ovaries’ potential response to medication-induced stimulation
- select the appropriate IVF protocol
- determine the medication dosage
- set realistic expectations regarding the number of eggs that may be retrieved
The correct interpretation of AFC measurement allows for careful planning, reducing the risk of overstimulation or inadequate response and increasing the likelihood of an optimal outcome.
Especially in women with low ovarian reserve or of advanced reproductive age, timely evaluation is a decisive factor in planning the next steps.
equently Asked Questions (FAQ)
The number of follicles recorded with AFC measurement differs significantly from one woman to another. Ovarian reserve is not the same for everyone and is influenced mainly by age, but also by individual biological factors.
Younger women usually show a higher number of small follicles, while over the years this number naturally declines. This decrease is part of the normal reproductive process and does not necessarily mean an inability to conceive.
The evaluation of the Antral Follicle Count (AFC) is based not only on the total number of follicles, but also on:
- the woman’s age
- cycle regularity
- AMH levels
- overall reproductive history
A lower ovarian reserve may affect the time required to conceive or the response to fertility treatments, but it is not in itself a diagnosis of infertility. Likewise, a high number of follicles does not necessarily guarantee success.
The findings are always interpreted on an individual basis, within the context of the overall clinical picture.
There is no single “ideal” number of eggs that guarantees success in in vitro fertilization. The goal of treatment is to retrieve a sufficient number of mature eggs in order to increase the chances of creating healthy embryos.
Each woman’s response to ovarian stimulation is different and depends on:
- age
- ovarian reserve (AFC and AMH)
- medical history
- the stimulation protocol
In general, the more mature eggs are retrieved—within safe limits—the greater the chances of selecting good-quality embryos. However, egg quality is just as important as quantity and is influenced mainly by age.
Assessment of ovarian reserve (AFC) helps with realistic treatment planning and the selection of an appropriate stimulation protocol, in order to achieve the best possible outcome for each woman.
Ovarian reserve is determined to a large extent by biological and genetic factors and naturally declines with age. There is currently no treatment that can substantially and permanently increase the total number of eggs in the ovaries.
AMH (Anti-Müllerian Hormone) levels, which are used as an indicator of ovarian reserve, may show small fluctuations, but they do not change the underlying biological reality.
In cases of reduced ovarian reserve, the approach does not aim to “increase” the reserve, but rather to focus on:
- the right timing of the attempt
- the individualized selection of a treatment protocol
- optimizing the ovaries’ response
Timely evaluation through AFC measurement allows for realistic planning and informed decision-making, especially when reproductive planning is involved.
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