Antral Follicle Counts in Real Time

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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.


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