Antral Follicle Count - help interpreting my results?

boymamaco · June 2011

Hoping you all might have some insight for me. I went in today for my day 3 bloodwork and a baseline ultrasound. The lab tech said that my Antral Follicle Count was good. She didn't seem concerned about it at all.

On my Right ovary I had 4 follicles. On my Left ovary, I only had 1 (although she thought she saw several smaller ones she didn't count them as they were too small.)

I came home tonight and started researching AFC and it seems that 4 follicles is actually considered horrible. I found information on the Advanced Fertility.com site.

I am very concerned. I'm going to write them an email and hopefully get to talk to them tomorrow. My FSH was 7.4 (it was 4.1 last Oct.), Estradiol was 40, and LH was 4 (i think.) My AMH should be back tomorrow.

Any insights into AFC? Thanks!

Mrs.Slick · June 2011

I really have no advice but maybe it's only considered "horrible" on a non-medicated cycle?

diana.filipi · June 2011

Hmm, I think you should get that email out. How old are you? From what I've read and talked about with my RE I would think they would at least not say it was 'good'. The chart I found put those numbers in the not great range, pre-menopausal maybe even. I'm sure they will explain it well to you once you express your concern, after all it was a doc that told you it was good, right!

diana.filipi · June 2011

THIS research paper will give you some uplifting hope :-)

Abstract
OBJECTIVE:
To determine the clinical relevance of obtaining antral follicle counts (AFC) before ovarian stimulation in an IVF program.
DESIGN:
Retrospective cohort study.
SETTING:
An IVF program in a large academic teaching hospital.
PATIENT(S):
A total of 1,049 stimulated IVF cycles in 734 subjects between September 2003 and December 2007 selected from our program's database.
INTERVENTION(S):
Basal antral follicles (AFCs) (3 mm-10 mm) were counted via ultrasound scan on cycle day 3 in luteal leuprolide acetate stimulations, or after at least 2 weeks of oral contraceptives in microdose leuprolide acetate stimulations. Patients were grouped according to basal AFC, and outcome parameters compared for AFC groups within each stimulation protocol.
MAIN OUTCOME MEASURE(S):
Oocytes retrieved, ovarian response, implantation rate, cancellations, pregnancy, pregnancy loss, and live births per cycle start.
RESULT(S):
Antral follicle count grouping is predictive of threefold change in ovarian response to gonadotropins and oocytes retrieved. Low AFC did predict a higher cancellation rate. Antral follicle count did not predict implantation rate, pregnancy rate, or live birth rate per cycle start.
CONCLUSION(S):
Antral follicle count may be helpful in determining stimulation protocol, as it is the most reliable determinant of oocytes retrieved per starting FSH dose. Antral follicle count predicts ovarian response, not embryo quality or pregnancy.
Copyright ? 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

boymamaco · June 2011

diana.filipi:
Hmm, I think you should get that email out. How old are you? From what I've read and talked about with my RE I would think they would at least not say it was 'good'. The chart I found put those numbers in the not great range, pre-menopausal maybe even. I'm sure they will explain it well to you once you express your concern, after all it was a doc that told you it was good, right!

I'm 36. The indication that "it was good" was from the ultrasound technician. Then I met with my nurse but not my RE, and they didn't say anything about it. I know my RE looked at my results b/c I had something up with my right ovary due to a cyst I had removed last December.

Trying not to freak out right now. Tongue Tied

Diana ~ Thanks! I saw that too.... definitely provides a glimmer of hope.

diana.filipi · June 2011

lucyspeople:
diana.filipi:
Hmm, I think you should get that email out. How old are you? From what I've read and talked about with my RE I would think they would at least not say it was 'good'. The chart I found put those numbers in the not great range, pre-menopausal maybe even. I'm sure they will explain it well to you once you express your concern, after all it was a doc that told you it was good, right!

I'm 36. The indication that "it was good" was from the ultrasound technician. Then I met with my nurse but not my RE, and they didn't say anything about it. I know my RE looked at my results b/c I had something up with my right ovary due to a cyst I had removed last December.

Trying to to freak out right now.

Don't freak out! I'm the same age as you and had my AFC done yesterday. The RE did mine. She did count but didn't really dwell on it. I think it was 4 or 5 on the left with a big cyst pushing them all aside so she wasn't able to do a good count then on the right it was more I think but I don't remember.

That study I posted says that while a low AFC (and while your numbers aren't high by any means I don't think they are 'low low') resulted in more cancelations it didn't matter in quality or live birth %s. That's good!

mdluv21 · June 2011

It does sound low to me but I am not sure it is the only indicator of your response to meds...your other numbers sound pretty good.

ChicagoWeded2007 · June 2011

She might have meant "measurable" follicles. In that case that would be a good count.

diana.filipi · June 2011

ChicagoWeded2007:
She might have meant "measurable" follicles. In that case that would be a good count.

I was gonna say some thing about that too. The count is going to be different with each different person. Another tech may have counted some of those follies this tech didn't count.

boymamaco · June 2011

Alright, you all are helping me feel a bit better. Thank you! Email is sent to the RE and we'll see what I get back tomorrow. Thanks for all the insight!

boymamaco · June 2011

Here is the response from the nurse at the RE's office.

Dr. S had already recommended that you repeat your ultrasound for evaluation of the ovaries again if you are not pregnant this month. After additional evaluation of the ovaries he will make recommendations. Yes, those are lower numbers of resting follicles but you may have more that we were not able to see at the time of your last baseline ultrasound because of the large follicle on the left and possibly the remnants of a dermoid cyst on the right.

They originally told me that Dr. S wasn't concerned about the possible remnant of the dermoid but wanted to recheck it next month to make sure it wasn't growing. They didn't mention anything about the low AFC. So I kind of feel like she is skirting the issue and that the recommendation is to just give this cycle a go, and then wait and see.

Sorry for the long email. I'm trying to not freak out and just "keep calm and carry on"... LOL

STL34 · June 2011

As a DOR patient, I can tell you that a true AFC of 4 is low (it is lower than any I have had). However, it doesn't sound like the tech did a true AFC. Because, for an AFC they are supposed to count all antral follicles, not just those of a certain size. I would definitely ask your RE about it. But, I am guessing that you can't use the normal scale due to the way the u/s was done.

STL34 · June 2011

lucyspeople:

Here is the response from the nurse at the RE's office.

Dr. S had already recommended that you repeat your ultrasound for evaluation of the ovaries again if you are not pregnant this month. After additional evaluation of the ovaries he will make recommendations. Yes, those are lower numbers of resting follicles but you may have more that we were not able to see at the time of your last baseline ultrasound because of the large follicle on the left and possibly the remnants of a dermoid cyst on the right.

They originally told me that Dr. S wasn't concerned about the possible remnant of the dermoid but wanted to recheck it next month to make sure it wasn't growing. They didn't mention anything about the low AFC. So I kind of feel like she is skirting the issue and that the recommendation is to just give this cycle a go, and then wait and see.

Sorry for the long email. I'm trying to not freak out and just "keep calm and carry on"... LOL

Cysts can definitely affect your AFC, too. So, if you had had a cyst recently, the AFC might not have been reliable. Also, if you have an abnormally large follicle (often a cyst when done on CD3), it can affect your AFC.

ChicagoWeded2007 · June 2011

lucyspeople:

Here is the response from the nurse at the RE's office.

Dr. S had already recommended that you repeat your ultrasound for evaluation of the ovaries again if you are not pregnant this month. After additional evaluation of the ovaries he will make recommendations. Yes, those are lower numbers of resting follicles but you may have more that we were not able to see at the time of your last baseline ultrasound because of the large follicle on the left and possibly the remnants of a dermoid cyst on the right.

They originally told me that Dr. S wasn't concerned about the possible remnant of the dermoid but wanted to recheck it next month to make sure it wasn't growing. They didn't mention anything about the low AFC. So I kind of feel like she is skirting the issue and that the recommendation is to just give this cycle a go, and then wait and see.

Sorry for the long email. I'm trying to not freak out and just "keep calm and carry on"... LOL

Sounds like they didn't really understand your question. But sounds like everything is fine. Good luck!

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Antral Follicle Count - help interpreting my results?

Re: Antral Follicle Count - help interpreting my results?

Abstract

OBJECTIVE:

DESIGN:

SETTING:

PATIENT(S):

INTERVENTION(S):

MAIN OUTCOME MEASURE(S):

RESULT(S):

CONCLUSION(S):

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