Tag: antral follicle count (AFC)

  • What is Ovarian Reserve? How to Test It. Can You Improve Your Egg Quality?

    1. What is Ovarian Reserve?

    A woman is born with 1–2 million eggs, but by puberty, only about 300,000–400,000 remain. With each menstrual cycle, a number of eggs is lost, and only one matures for ovulation. By the time a woman reaches her late 30s and early 40s, the number and quality of her eggs decline significantly​.

    What is Ovarian Reserve Importance?

    · It helps predict natural fertility potential.

    · It determines the likelihood of success with fertility treatments.

    · It indicates the timing of menopause.

    Does Low Ovarian Reserve Mean Infertility?Not necessarily. A woman with a low ovarian reserve can still conceive, but her chances decrease with age, especially after 35 years old​.

    2. How to Test Ovarian Reserve?

    A. Hormonal Blood Tests

    Test What It Measures Optimal Range

    Anti-Müllerian Hormone (AMH). Ovarian reserve 1.0–4.0 ng/mL (ideal fertility)

    Follicle-Stimulating Hormone (FSH). Ovarian function <10 mIU/mL (tested on Day 3 of the cycle)

    Estradiol (E2) Egg development response. 25–75 pg/mL (Day 3 test)

    Inhibin B. Ovarian activity. >45 pg/mL suggests good reserve

    • AMH is the most reliable marker, as it remains stable throughout the menstrual cycle.

    • FSH and estradiol levels are useful but may fluctuate from cycle to cycle​.

    B. Ultrasound Tests

    1. Antral Follicle Count (AFC) – Measures the number of small follicles in both ovaries via transvaginal ultrasound.

      • High AFC (>12 follicles) = Good ovarian reserve.

      • Low AFC (<5 follicles) = Diminished reserve.

    2. Ovarian Volume – Women with larger ovarian volume tend to have better fertility outcomes​.

    3. Factors That Affect Ovarian Reserve

    A. Aging

    · Egg count declines naturally after 30 and rapidly after 35.

    · Egg quality decreases, increasing the risk of chromosomal abnormalities such as Down syndrome.

    B. Lifestyle Factors

    • Smoking – Reduces ovarian reserve and advances menopause by 1–4 years.

    • Obesity – Alters hormonal balance, impacting egg quality.

    • Excessive alcohol – Lowers AMH and damages egg DNA​.

    C. Medical Conditions

    • Polycystic Ovary Syndrome (PCOS) – Can result in higher AFC but poorer egg quality.

    • Endometriosis – Causes ovarian damage, reducing egg supply.

    • Autoimmune diseases – May lead to early ovarian failure​.

    D. Family History

    · A family history of early menopause increases the likelihood of low ovarian reserve.

    4. Can You Improve Ovarian Reserve?

    The Truth About Supplements and Egg Quality

    · There is no proven way to increase the number of eggs a woman has.

    · Some studies suggest that Coenzyme Q10 (CoQ10) may help mitochondrial function in eggs, but it does not reverse genetic aging​.

    · No supplement can prevent chromosomal abnormalities in eggs caused by age​.

    Best Strategies for Protecting Egg Quality

    1. Lifestyle modifications – Avoid smoking, excessive alcohol, and maintain a balanced diet.

    2. Consider egg freezing at a younger age – If planning delayed pregnancy.

    3. Fertility assessment – Regular testing to understand reproductive health​.

    5. Fertility Treatments for Low Ovarian Reserve

    • Mild ovarian stimulation – Lower doses of fertility drugs for better egg quality.

    • Egg freezing (oocyte cryopreservation) – A great option for women with declining ovarian reserve who wish to conceive later.

    • IVF with preimplantation genetic testing (PGT-A) – Helps select chromosomally healthy embryos​.

    6. Conclusion: What is Ovarian Reserve? Why  you should it.

    Ovarian reserve is a key factor in fertility, but a low reserve doesn’t mean pregnancy is impossible.

    · AMH and AFC are the best predictors of ovarian reserve.

    · Egg quality is just as important as quantity for successful conception.

    · No supplement has been proven to increase egg quantity or reverse age-related decline.

    Women considering pregnancy—especially after 30—should undergo fertility testing early to explore their options for natural conception or fertility preservation.

    What is ovarian reserve? You Know the answer. Share this post and help us spread the word!

    Would you like to assess your ovarian reserve? Book a consultation with a fertility specialist today!

    References

    1. Cardim, H.J.P. Vencendo a Dificuldade de Engravidar. Editora Pensamento-Cultrix Ltda, 2009​.

    2. American Society for Reproductive Medicine (ASRM). “Ovarian Reserve Testing: What You Need to Know.” Fertility and Sterility, 2023.

    3. Nelson, S.M. “Antimüllerian Hormone and Ovarian Reserve Assessment.” Endocrinology and Metabolism Clinics of North America, Vol.50, No.3, 2021, pp. 485-500.

    4. Wallace, W.H.B., & Kelsey, T.W. “Human Ovarian Reserve from Conception to Menopause.” PLoS ONE, 2010.

  • Investigating Infertility: The Most Accurate Tests for Women and Men

    1. Investigating Infertility:When Should You Get Tested for Infertility?

    Doctors recommend fertility testing if:

    • A woman under 35 has been trying to conceive for 12 months without success.

    • A woman over 35 has been trying for 6 months without success.

    • A woman has irregular or absent menstrual cycles.

    • A man has a history of low sperm count, erectile dysfunction, or hormone issues.

    • A couple experiences multiple miscarriages​.

    The choice of tests depends on age, medical history, lifestyle, and suspected reproductive health conditions.

    2. Investigating Infertility:Fertility Tests for Women

    A. Hormonal Blood Tests

    These tests assess ovarian reserve (egg supply), menstrual cycle regularity, and reproductive hormone balance:

    Test Purpose Ideal Value for Fertility

    Anti-Müllerian Hormone(AMH) Measures ovarian reserve 1.0–4.0 ng/mL

    Follicle-Stimulating Hormone (FSH) Assesses ovarian function. <10 mIU/mL on day 3

    Luteinizing Hormone (LH). Indicates ovulation issues. 5–20 mIU/mL on day 3

    Estradiol (E2) Evaluates ovarian response. 25–75 pg/mL on day 3

    Progesterone Confirms ovulation >3 ng/mL after ovulation

    Prolactin Identifies hormonal imbalances 2–29 ng/mL

    Thyroid Hormones (TSH & T4) Assesses thyroid function, which affects ovulation TSH: 0.4–4.0 mIU/L

    These tests are usually done on specific days of the menstrual cycle to get the most accurate results​.

    B. Ultrasound Tests

    Transvaginal Ultrasound helps evaluate:

    • Antral Follicle Count (AFC) – Measures how many eggs are available for retrieval.

    • Ovarian cysts or polycystic ovaries (PCOS).

    • Fibroids or uterine abnormalities that can affect implantation​.

    C. Ovulation Tracking

    Doctors may recommend tracking ovulation through:✔ Basal Body Temperature (BBT) charting – Slight increase in temperature after ovulation.✔ Ovulation predictor kits (OPKs) – Detects LH surge before ovulation.✔ Blood tests – Measures progesterone levels post-ovulation​.

    D. Fallopian Tube and Uterus Testing

    1. Hysterosalpingography (HSG) – An X-ray test using contrast dye to check if fallopian tubes are open.

    2. Sonohysterography – Uses ultrasound to detect polyps, fibroids, or uterine shape abnormalities.

    3. Hysteroscopy – A small camera is inserted into the uterus to directly examine the endometrial lining​.

    If any blockages or abnormalities are found, surgical intervention may be needed to restore fertility.

    3. Investigating Infertility:Fertility Tests for Men

    A. Semen Analysis

    A semen analysis evaluates:

    • Sperm count – Normal is 15 million or more per milliliter.

    • Sperm motility (movement) – At least 40% should be active.

    • Sperm morphology (shape and size) – At least 4% normal shape.

    • Volume – Normal is 1.5–5 mL per ejaculation​.

    B. Hormonal Tests

    Men also need hormonal evaluations:

    • Testosterone – Regulates sperm production (Normal: 300–1,000 ng/dL).

    • FSH & LH – Stimulates sperm production (Normal: 1.5–12.4 mIU/mL).

    • Prolactin – High levels may indicate pituitary dysfunction.

    • Estradiol (E2) – Important for sperm maturation (Normal: 10–40 pg/mL)​.

    C. Genetic Testing

    If a man has severe sperm issues, genetic tests may identify Y-chromosome microdeletions or chromosomal abnormalities, such as Klinefelter Syndrome​.

    4. What Happens After Testing? Treatment Options

    Based on the results, possible fertility treatments include:

    A. Lifestyle Changes

    ✔ Maintaining a healthy weight.✔ Reducing alcohol, smoking, and caffeine.✔ Managing stress and sleep patterns​.

    B. Medications for Women

    • Clomiphene citrate – Induces ovulation.

    • Letrozole – Stimulates egg production.

    • Gonadotropins (FSH, LH injections) – Used in IVF or IUI cycles.

    C. Assisted Reproductive Technologies (ART)

    1. Intrauterine Insemination (IUI) – Sperm is placed directly in the uterus.

    2. In Vitro Fertilization (IVF) – Eggs are retrieved, fertilized, and implanted.

    3. Intracytoplasmic Sperm Injection (ICSI) – A single sperm is injected into an egg, useful for male infertility.

    4. Egg or sperm donation – If natural conception is not possible​.

    5. Conclusion: Investigating Infertility:The Importance of Early Testing

    Early fertility testing can identify potential issues and help couples make informed decisions about their reproductive future.

    Women should check their ovarian reserve by age 30 if planning to delay pregnancy.

    Men should have a semen analysis if conception is unsuccessful after 12 months.

    Advanced fertility treatments exist for many causes of infertility.

    If you’re struggling to conceive, schedule a fertility evaluation today!

    References

    1. Cardim, H.J.P. Vencendo a Dificuldade de Engravidar. Editora Pensamento-Cultrix Ltda, 2009.

    2. Eekelen, R. van, et al. “Natural Conception: Repeated Predictions Over Time.” Human Reproduction, Vol.32, No.2, 2017, pp. 346–353. DOI:10.1093/humrep/dew309​.

    3. Guerriero, S., Condous, G., & Alcázar, J.L. How to Perform Ultrasonography in Endometriosis. Springer International Publishing, 2018.

    4. Barreto, N.C.N. “Predição do Sucesso de Gestação Utilizando Algoritmos de Machine Learning Após Procedimentos de Fertilização In Vitro.” Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Análises Clínicas e Toxicológicas, 2021​.

    5. Silva, G.M. et al. “Number of Antral Follicles and the Success of In Vitro Fertilization: A Multivariate Analysis.” Brazilian Journal of Human Reproduction, 2012​.