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Comparing Antral Follicle Count to Other Ovarian Reserve Testing

Antral follicle count is another measure of a woman’s overall fertility, or “ovarian reserve.” Watch Dr. Gleicher discuss this kind of testing, as well as how antral follicle count compares to FSH and AMH testing.

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Hello, I want today to discuss with you a subject that we are very frequently asked about and that is the so called, “antral follicle count.” Every fertility patient probably knows that at the core of every fertility diagnosis in women is what is called the “ovarian reserve,” or what we here at CHR call the “functional ovarian reserve.”

And most infertility patients also know that our main tool in assessing how much ovarian reserve a woman are blood tests– hormonal tests of follicle stimulating hormone (FSH) and of anti-mullerian hormone (AMH). Those are the two standard tests. Both go into opposite direction– with FSH rising as a woman ages and AMH declining. And both do that kind of in concert. So as a woman’s ovarian reserve declines, FSH rises and AMH declines.

The antral follicle count is another means of testing ovarian reserve. It is very popular in Europe– especially in Europe and, frankly speaking, I have no idea why that is. But it may simply be more practical for our European colleagues to do antral follicle count because it is usually more complex to get blood tests done. The antral follicle count also quite reliably assesses the functional ovarian reserve by counting those tiny little antral follicles that are seen at the beginning of every cycle.

The number of antral follicles usually directly relates to FSH and AMH levels, but with one caveat. And this is actually the reason why we here at CHR– while looking at antral follicles— do not use the antral follicle count in our assessment of patients. And that one caveat is that in contrast to testing FSH and AMH levels, which are pretty much always the same at least if you use the same laboratory, the antral follicle count is very much provider dependent.

We tested that out a few years ago when antral follicle count first came into practice and we found that amongst our physicians, the counts differed too much in order to really rely on them in place of FSH and AMH. And that is the reason why at CHR, your ovarian functional reserve is in principle only evaluated by FSH and AMH. Thank you.