Antral Follicle Count: What Your AFC Means for IVF, Egg Freezing, and Fertility

Navigating the world of fertility can feel like stepping into a maze filled with new terms, tests, and numbers that all seem critical—but maybe a little mysterious, too. One term that you’re likely to hear a lot is Antral Follicle Count, or AFC. In my work as a fertility specialist, the Antral Follicle Count (AFC) test is one of the first tools I reach for to help my patients understand their ovarian reserve, particularly when they’re considering IVF, egg freezing, or just want to get a clearer picture of their fertility health. AFC, along with other fertility markers, plays a significant role in shaping the fertility journey, especially when it comes to creating a personalized treatment plan.

My name is Dr. Lucky Sekhon and I am a practicing REI in New York and the author of this blog. In my practice, I help hundreds of patients each year to preserve their fertility and overcome issues relating to infertility. In this post, I’ll break down what AFC can (and can’t) tell you about your fertility, why it matters for those pursuing IVF or egg freezing, and why it’s important to remember that one number doesn’t define your entire fertility potential. The goal here is to make the fertility journey less overwhelming, more empowering, and help you focus on what truly matters. If you’d like to stay up to date on my fertility and reproductive health updates, please follow me on Instagram or subscribe to my monthly mailing list where I regularly share updates on various aspects of the fertility journey.

What Is Antral Follicle Count?

Antral Follicle Count is a fancy name for a not-so-fancy process: it’s simply a count of the small, fluid-filled follicles in your ovaries at the start of your menstrual cycle. Imagine your ovaries as an egg carton, and these antral follicles as the eggs in that carton. But these aren’t quite the “ready-to-go” eggs; they’re more like potential eggs. Each follicle could become an egg, given the right stimulation.

Here’s an important thing to remember: AFC tells you about quantity, not quality. It’s like getting a box of chocolates—your AFC will tell you how many chocolates are in the box, but it won’t tell you if any of them are, say, that dreaded coconut flavor. That’s the catch with AFC: while it gives a count of how many potential eggs are growing in your ovaries, it doesn’t tell you if those eggs are genetically healthy or high-quality.

How does your doctor get this count? It’s done through a transvaginal ultrasound (yes, it’s that probe ultrasound you might have heard about) on cycle days 2 to 5. During this ultrasound, your doctor counts the visible follicles in each ovary. This number gives a snapshot of what’s going on in your ovarian reserve—or, in simpler terms, your egg supply.

What Does Antral Follicle Count Tell You About Your Fertility?

If you’re looking to conceive on your own—without IVF or egg freezing—you might be wondering whether your Antral Follicle Count (AFC) has any bearing on your ability to get pregnant? Here’s some good news: AFC, just like AMH, is not a major predictor of your chances of conceiving naturally or even with fertility treatments like IUI (intrauterine insemination)! While it’s a valuable metric for understanding your ovarian reserve overall, it’s not as critical when it comes to monthly ovulation and conception. Here’s why: as long as you have a regular menstrual cycle, your body is selecting and releasing one egg each month—regardless of whether you have a higher or lower AFC. AFC measures the count of potential eggs sitting in your ovaries, but for ‘natural’ conception, this “extra” egg reserve doesn’t play a role in the success of ovulation or conception each month. In other words, your ovaries will pick one dominant follicle to ovulate, and the total number of other follicles hanging around doesn’t change the quality or timing of that egg.

If you have a lower AFC, it means there may be fewer eggs in your reserve over the long term, but it doesn’t impact the monthly ovulation process or the quality of the egg released. Think of it this way: AFC is like a general inventory of your ovarian “stock” for the future. It’s more relevant for situations where we’re trying to retrieve multiple eggs at once—like in IVF or egg freezing—where quantity matters because we want as many eggs as possible in a single cycle. But for conception through intercourse or IUI, all that matters is that you’re regularly ovulating one egg each month! So, if you’re just trying to get pregnant at home, AFC is a nice-to-know rather than a need-to-know metric. Don’t let it stress you out! Focus on understanding your cycle, tracking ovulation if that feels helpful, and letting your body do its thing. And remember, fertility isn’t defined by one number; it’s a holistic picture that includes everything from regular ovulation to overall reproductive health.

What Does Antral Follicle Count Mean for IVF and Egg Freezing?

If you’re considering IVF or egg freezing, Antral Follicle Count (AFC) becomes a key player in your fertility plan. AFC gives your fertility specialist a preview of how your ovaries might respond to the stimulation medications used in both IVF and egg-freezing cycles, where the goal is to retrieve as many eggs as possible in a single round. The more eggs we can retrieve, the more chances we have to work with, whether it’s for embryo creation in IVF or for future fertility preservation through egg freezing.

AFC Range	Potential Stimulation Response
High (15-30+)	Likely good response, potentially more eggs retrieved.
Medium (8-14)	Expected moderate response, good egg yield possible.
Low (1-7)	Likely fewer eggs retrieved, but quality still matters.

A higher AFC often signals that your ovaries may respond well to stimulation, potentially leading to a larger number of eggs retrieved in one cycle. This can be particularly useful in IVF, where more eggs give us more embryos to select from. For egg freezing, a higher AFC can mean fewer rounds needed to reach your target number of frozen eggs, saving you both time and cost.

On the flip side, a lower AFC might mean that your ovaries have fewer follicles to stimulate in a single cycle. But that doesn’t necessarily spell bad news! With a tailored approach, many people with a lower AFC still achieve success with IVF or egg freezing. Your fertility specialist will customize your medication protocol to make the most of each follicle, and it’s often possible to achieve great results by simply adjusting the stimulation approach to fit your specific needs.

How Stimulation Protocols are Adjusted For Antral Follicle Count?

When it comes to tailoring IVF or egg freezing protocols, Antral Follicle Count (AFC) is an important data point fertility specialists use to come up with the right treatment plan for a patient. A high or low AFC can steer the approach we take with ovarian stimulation, helping us maximize the potential of each cycle while keeping safety in mind. Here’s how I typically adjust stimulation protocols for patients with low versus high AFC values.

For those with a low AFC (generally around 1-7 follicles), the focus is on making the most of each follicle. In these cases, I’ll often start with a higher dose of gonadotropins (FSH and LH) to encourage every available follicle to grow and develop as much as possible. Since we’re working with a smaller group of follicles, giving them a stronger push right from the start can help us capture each follicle’s potential. Sometimes, I’ll add medications like androgens (such as DHEA) or even growth hormone to support follicle response and enhance egg quality, particularly if response has been an issue in previous cycles. With lower AFC patients, I also monitor closely throughout the cycle, making adjustments as needed to ensure we’re getting the best response we can from each follicle.

On the other hand, for patients with a high AFC (typically 15-30+ follicles), I take a more conservative approach to avoid overstimulation. High AFC suggests that the ovaries are highly responsive, so we usually start with lower doses of gonadotropins to gently stimulate the follicles without causing an excessive reaction. For these patients, I often use an antagonist protocol, where we start medications midway through the cycle to prevent premature hormone surges, giving us more control over follicle growth. To reduce the risk of ovarian hyperstimulation syndrome (OHSS), which can happen with high follicle counts, I might use a “Lupron trigger” (GnRH agonist) instead of the usual HCG trigger to mature the eggs before retrieval. This approach keeps the process safer and minimizes discomfort after the retrieval.

What Can Influence Your Antral Follicle Count? (Hint: It’s Not Just Age)

While AFC tends to decrease with age (particularly noticeable after your mid-30s), it’s not the only thing that influences this number as hormonal medications, cycle variability and the manual nature of obtaining an AFC count can cause the numbers to jump around.

While AFC gives valuable insights into your ovarian reserve, it’s important to remember that this count isn’t a precise, flawless measurement. During an AFC scan, your doctor is working with a 2D ultrasound projection of a 3D structure—your ovaries—which can make it challenging to see every single follicle with perfect clarity. Follicles can “hide” in the depths of the ovaries or overlap in ways that make them hard to count. For a variety of reasons, it’s not uncommon for some follicles to go unseen in an initial scan.AFC can also fluctuate naturally from cycle to cycle, and sometimes even within a single cycle. In fact, once ovarian stimulation begins (as with IVF or egg freezing), it’s typical to see the AFC count increase as follicles become more pronounced and visible under the influence of stimulation medications. Essentially, those “sleeping” follicles wake up, becoming easier to see on an ultrasound. So, if your AFC seems lower than expected at first, don’t stress—there’s a good chance that stimulation will reveal additional follicles, providing more eggs to work with as the cycle progresses.

The Impact of Hormonal Medications Like Birth Control on Antral Follicle Counts

If you’re on hormonal medications, like birth control pills, don’t be surprised if they impact your AFC count. Birth control is designed to suppress ovarian activity, preventing the follicles from maturing or becoming as visible. When a patient on birth control comes in for an AFC scan, it’s common to see a temporarily lower follicle count because these medications keep the follicles in a resting state. This isn’t a reflection of your true ovarian reserve—it’s more of a snapshot of how the ovaries look while they’re under suppression. If you’re considering fertility treatments and need an accurate AFC reading, it’s often recommended to pause birth control for a cycle or two before the scan, allowing the follicles to return to their natural state. This way, we can get a clearer and more reliable assessment of your ovarian reserve.

How Does AFC Compare with AMH Testing?

When it comes to assessing ovarian reserve, Antral Follicle Count (AFC) and Anti-Müllerian Hormone (AMH) testing are the two go-to metrics, but they measure things a bit differently. Think of them as two sides of the same coin—both give insights into egg quantity, but they do so in unique ways that make each useful in different situations.

As I mentioned above, AFC is essentially a headcount of the small, fluid-filled follicles visible in your ovaries at the start of your menstrual cycle. The biggest strength of AFC is that it’s a real-time look at your ovarian reserve, giving a snapshot of your follicle count in that exact cycle. AMH is a hormone produced by the small, immature follicles in your ovaries, so the level of AMH in your blood gives an indirect measure of your egg quantity. Unlike AFC, which fluctuates slightly each cycle, AMH is a bit more stable, making it easier to test at any point in your cycle. It provides a broader overview of your ovarian reserve over time rather than a snapshot of one particular cycle. This consistency makes AMH a useful measure for predicting ovarian reserve longevity and planning for fertility preservation. Both AMH and AFC are most relevant in the context of ovarian stimulation treatments like IVF and egg freezing, for conception at home and IUI these metrics are less important.

Feature	AFC (Antral Follicle Count)	AMH (Anti-Müllerian Hormone)
How It’s Measured	Transvaginal ultrasound on cycle days 2-5	Blood test, any day of the cycle
What It Measures	Real-time count of small follicles	Hormone level reflecting follicle reserve
Cycle Variability	Can vary slightly between cycles, also more error prone as it requires a doctor to count on follicles on an ultrasound.	Generally stable across cycles
Limitations	Can fluctuate; only useful in current cycle	Doesn’t give info on current cycle

Check out my AMH Level Checker to see how your AMH level compares to normative values for your age group.

What AMH and AFC Together Might Indicate About Ovarian Reserve?

To help make sense of how AFC and AMH work together in understanding ovarian reserve, here’s a quick-reference table. Different combinations of high and low AFC and AMH values can give us insights into how your ovaries might respond to fertility treatments like IVF or egg freezing and what each combination might mean for your overall fertility planning. Use this guide to see what your unique numbers could indicate and how they might shape your fertility approach.

	Low AMH	High AMH
Low AFC	Suggests diminished ovarian reserve. Lower response expected, may require higher stimulation doses with realistic expectations for lower egg yield.	Possibly good long-term reserve with fewer visible follicles. More follicles might respond under stimulation than initially seen.
High AFC	Indicates good current follicle visibility, but ovarian reserve may be declining. Good response possible now, but future cycles may see fewer follicles.	Likely strong ovarian reserve, suggesting a favorable response to stimulation. Good for IVF/egg freezing, often yielding higher egg counts per cycle.

Wrapping It Up: What Antral Follicle Count Can (and Can’t) Tell You

So, what’s the AFC takeaway? Knowing your Antral Follicle Count is a great starting point for understanding your fertility options, especially if you’re considering IVF or egg freezing. It can help your doctor tailor treatments to your needs, give you realistic expectations, and help you make informed decisions. But AFC is not a crystal ball, and it doesn’t have the final word on your fertility.

If your AFC is lower than expected, try not to let it bring you down. This is where talking with a fertility specialist can help. They’re there to interpret your AFC in the context of all your test results and to help you navigate options that work best for you. At the end of the day, you’ve got options, information, and, most importantly, support.

And remember, in the world of fertility, patience and resilience go a long way. Every journey looks different, and sometimes the best thing you can do is take each step as it comes, letting the numbers guide but not control your journey. If you are interested in continuing to learn more about ovarian reserve measures such as AFC and AMH, please follow me on Instagram where I regular post new updates on topics such as these. To stay in the loop with the latest fertility topics and information I publish, please subscribe to my monthly “Lucky Egg Drop” newsletter.

If you are local to New York City and are interested in booking a consultation with me, you can submit an appointment request here.