Why does CHR not use the antral follicle count (AFC)?

Many colleagues, especially in Europe, frequently use the so-called antral follicle count (AFC) to assess functional ovarian reserve (FOR). As AFC denotes in its name, it represents an assessment of the so-called antral follicles in both ovaries. Although antral follicles are the smallest follicles visible on ultrasound, they represent quite an advanced stage of follicle maturation. Indeed, they are already beyond what is called the small growing follicle stage, where DHEA and human growth hormone (HGH) are effective in affecting the number and quality of the eggs.

The AFC has been demonstrated to correlate reasonably well with FSH as well as AMH levels in determining FOR. At CHR, our studies have, however, suggested that the sonographic assessments of AFCs differ too much between physicians. This does not mean that CHR does not look at AFCs and often even records them but CHR does not use AFCs to determine stimulation protocols for each patient. Instead, the reliance is on FSH, AMH, estradiol levels and very accurate follicle size assessments. The latter has in recent years gained additional importance because of Highly Individualized Egg Retrieval (HIER), which, considering CHR’s patient population, now a majority of the center’s patients are treated with.

This is a part of the November 2018 CHR VOICE.

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.