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Antral Follicle Counting with Ultrasound Video

Antral follicles are a measure of egg supply for the future (ovarian reserve) and help predict chances for successful IVF treatment

The antral follicle count is a fairly simple test to perform with high quality ultrasound equipment. It allows us to evaluate a woman's ovarian reserve - her supply of eggs for the future. Tests of ovarian reserve do not measure the quality of the eggs, they only measure the quantity.

Egg quality is mostly an age related issue. Quantity is something that we can test with "ovarian reserve tests". Most fertility doctors in the US rely on 3 ovarian reserve tests to evaluate their patients.

The single best ovarian reserve test is an antral follicle count.

Watch this video to learn about antral follicle counts and see how we do the test

Video transcript:

I'm Dr. Richard Sherbahn with the Advanced Fertility Center of Chicago. I am going to talk about antral follicle counts and ovarian reserve. Antral follicles are small cystic structures within the ovaries that can be visualized with ultrasound.

By counting the number of antral follicles we can learn about the quality of eggs remaining. We also can learn about the expected response to ovarian stimulation drugs and we can predict chances for successful in vitro fertilization treatment.

We are going to show some real-time ovarian assessment of antral follicle counts on 3 different ovaries. One with an average number of antral follicles, a second with low antrals, and a third with a high count.

We are slowly scanning through the ovary of a young woman. As we go through we can count the small 2-9 mm follicles. We see that this ovary has about 13 antral follicles. This is a pretty normal antral count for a woman in her 20s or early 30s.

This next ovary is from a patient with low ovarian reserve and small ovaries. This ovary shows only 3 antral follicles.

This third ovary is polycystic and shows high reserve and a very high antral count. Ovaries like this are difficult to get an accurate antral count on. This very polycystic ovary has over 50 antrals.

This graph shows IVF live birth rates at our center for couples with a female partner under age 35. Patients are split into 4 antral groups – high, medium-high, medium low, and low.

The live birth rates per cycle are shown in the blue columns. Cycle cancellation rates for inadequate response to ovarian stimulating drugs are shown in the yellow columns. The average number of eggs retrieved for each antral group is shown in red text above the columns.

IVF live birth rates are substantially lower and rates of cancellation are higher in women with lower antrals as compared to higher antrals. More graphs like this one showing IVF outcomes for women older than 35 years old are on our website.

In summary, ovarian reserve refers to assessment of the quantity, or reserve, of eggs remaining for the future. There are several ovarian reserve tests available but the most useful and reliable one is the antral follicle count.

Learn more about antral follicles, ovarian reserve testing and egg quantity and quality:

Antral follicle counts

Ovarian reserve

Day 3 FSH blood test

AMH blood test

Age and fertility

Egg quantity and quality

IVF stimulation protocols

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