How Ovarian and Antral Follicles Connect with Fertility


What is Ovarian Reserve, AMH and Antral follicle count?

Video taken from the channel: IDEAL FERTILITY


Comparing Antral Follicle Count to Other Ovarian Reserve Testing

Video taken from the channel: Center for Human Reproduction


Endometrioma and Antral follicle count: How can we predict ovarian response and improve success

Video taken from the channel: Fertility Courses


3 Min Histology Antral Follicles

Video taken from the channel: Chapman Histology


How Many Follicles?! ⎮ Baseline Ultrasound Before IVF

Video taken from the channel: The Stews


Antral Follicle Counts in Real Time

Video taken from the channel: Advanced Fertility Center of Chicago


Assessing Fertility: Day 3s, AMH/FSH, and Ultrasounds Dr. Daniel Stein

Video taken from the channel: RMA of New York

Antral follicles produce higher levels of a hormone known as anti-mullerian hormone (AMH), which circulates in the blood. Measuring AMH levels via blood testing is another way to evaluate ovarian reserves. Unlike FSH and estradiol (most accurate on day 2 of the cycle), AMH levels can be drawn at any time of the cycle).

The number of antral follicles present in the ovaries could give the potential number of eggs remaining. Antral follicles usually produce a hormone called anti-mullerian hormone (AMH) that circulates in the blood. Ovarian reserves are evaluated by measuring the level of AMH in the blood (7). Mostly all follicles release the egg but its maturity and quality can decide the level of fertility.

For the evaluation of ovarian follicles, doctors suggest a pelvic ultrasound scan of the womb and ovaries along with the AntiMullerian Hormone blood test. Through the scan, doctors can know about the size and number of follicles present in the ovaries which are called Antral Follicle. The Antral Follicle Count is a swift indicator of fertility.

You make a golden egg every month. Your Antral Follicle Count indicates how well your ovaries are functioning. Women with low Antral Follicle Count (AFC) are an ongoing problem for the medical community. There is confusion about what it means, and what the numbers represent. The rest will recede as the dominant follicle releases its egg and the cycle continues.

Prior to ovulation, these antral follicles – also called resting follicles – can be identified and counted using a transvaginal ultrasound. Since a higher number of follicles indicates a greater likelihood of fertility, USC Fertility teams typically use this procedure in conjunction with other female fertility tests to measure ovarian reserve and assess the potential for conception. In our experience, there is a clear relationship between lower antral follicle counts and lower pregnancy rates. This makes sense, since we know that antral counts predict egg number at retrieval, and higher egg numbers at retrieval means (on.

The Basal Antral Follicle Count test is a transvaginal ultrasound study that measures a woman’s ovarian reserve, or her remaining egg supply. The ovarian reserve reflects her fertility potential. Unlike men, who produce sperm on an ongoing basis, females are born with a lifetime supply of eggs in their ovaries. How high can it go?

Egg donors or young infertility patients might have an antral follicle count of 17 or more. The typical mid-30 year old infertility patient will have 5-10 antral follicles. Sometimes in women with low ovarian reserve it is tempting to try to find a cycle with more antral follicles in order to get a slightly better result.

Women have lower pregnancy rates with both ovulation induction therapy and IVF if their FSH levels are high at either time. Antral follicle count. A transvaginal ultrasound may be done in the early part of the menstrual cycle to count the number of small (2mm-10mm) follicles in the ovary. These are called antral follicles, and are where eggs develop.

Almost nearing ovulation, rapid follicle growth takes place, and follicle starts protruding from the ovarian cortex, attains a crenated border, and it literally explodes to release the ovum, along with some antral fluid.

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Subsequently, the follicles accumulate in the ovarian cortex but do not proceed normally toward ovulation or atresia.

“Encyclopedia of Environmental Health” by Jerome O. Nriagu
from Encyclopedia of Environmental Health
by Jerome O. Nriagu
Elsevier Science, 2019

Each ovary contains follicles where the eggs grow, thanks to the follicle stimulating hormone (FSH) which triggers the release of oestrogen inside the developing follicle, while a second hormone, luteinising hormone (LH), encourages further growth of the follicle and stimulates ovulation mid-cycle.

“The Good Menopause Guide” by Liz Earle
from The Good Menopause Guide
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After early antral follicles are formed, ovarian cell apoptosis increases.

“Clinical Reproductive Medicine and Surgery” by Tommaso Falcone, William W. Hurd
from Clinical Reproductive Medicine and Surgery
by Tommaso Falcone, William W. Hurd
Mosby/Elsevier, 2007

As the follicles grow they acquire FSH and LH receptors and become increasingly gonadotropin dependent, with antral follicles completely dependent on FSH for granulosa cell proliferation and LH for theca cell sex steroidogenesis.

“Oxford Textbook of Obstetrics and Gynaecology” by Sabaratnam Arulkumaran, William Ledger, Stergios Doumouchtsis, Lynette Denny
from Oxford Textbook of Obstetrics and Gynaecology
by Sabaratnam Arulkumaran, William Ledger, et. al.
Oxford University Press, 2019

During fetal life, the ovaries contain approximately 1to 2 million follicles—the maximumnumber of follicles awoman willever have.2 The lossof follicles eventually leading to menopause occurs primarilydue to atresia, not ovulation, because most women

“Varney's Midwifery” by Tekoa L. King, Mary C. Brucker, Jan M. Kriebs, Jenifer O. Fahey
from Varney’s Midwifery
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Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate.

“Mayo Clinic A to Z Health Guide: Everything You Need to Know About Signs, Symptoms, Diagnosis, Treatment and Prevention” by The Mayo Clinic
from Mayo Clinic A to Z Health Guide: Everything You Need to Know About Signs, Symptoms, Diagnosis, Treatment and Prevention
by The Mayo Clinic
Time Incorporated Books, 2015

At least one follicle (a sac containing an egg and fluid) matures in an ovary during each cycle.

“Pathology E-Book: Implications for the Physical Therapist” by Catherine C. Goodman, Kenda S. Fuller
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The ovaries contain several subtypes of follicles: the primordial follicles, primary follicles, secondary follicles, pre-antral follicles, and antral follicles (AFs; >2 mm diameter).

“Textbook of Assisted Reproductive Techniques: Two Volume Set” by David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham
from Textbook of Assisted Reproductive Techniques: Two Volume Set
by David K. Gardner, Ariel Weissman, et. al.
CRC Press, 2017

Most follicles in the ovary undergo atresia.

“Medical Phisiology: Principles for Clinical Medicine” by Rodney A. Rhoades, David R. Bell
from Medical Phisiology: Principles for Clinical Medicine
by Rodney A. Rhoades, David R. Bell
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012

Normally, each month during a woman’s reproductive years, one ovarian follicle reaches maturity, and the ovum is ovulated, or expelled, from the ovary through the stimulus of the gonadotropic hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

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Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Bibliography: oktay_bibliography

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  • High FSH and Low AMH is not a good sign when wanting to conceive. But there is another part of me that reads this a little different. Hormones are just part of the equation, absolutely they tell us a story, but this is the first chapter, and for most of us we go start to the last chapter to see the ending and normally well the ending ain’t too good, If and that a big if, you only look at as the numbers. Because there are lots and lots of women with High FSH getting pregnant around the world and they don’t know they have High FSH. There are lots and lots of women with Low AMH getting pregnant around the world and they don’t know they have Low AMH. There are lots and lots of women with High FSH and Low AMH around the world getting pregnant and they don’t know they have High FSH and Low AMH. A word of warning though. There are lots of women not getting pregnant also. And that’s when your fertility Doctor becomes very important. Like in my case at Bio tex. And you need to listen to them. The important thing to remember here is that nature plays a massive part in the whole process there is so much we still don’t know. And more and more Doctors are now starting to dismiss the whole AMH results thing. FSH however has been around the block and is a time test valuation and should be taken seriously.

  • Age is a very important factor used to determine the quality of the female egg. In fact doctors use age as the most reliable measuring stick for female egg quality. According to what I came to learn about at Bio tex. A younger woman will have better quality eggs than an older woman. As women age the quality of eggs deteriorate. Doctors make a rough estimation about the quality of the female eggs based on the age of the patient. A poor responder is defined as one who responds poorly to ovarian stimulation. A woman’s ability to respond to the hormone injections administered during IVF treatment to stimulate the ovaries to mature additional eggs defines how well she responds. Generally a good responder would be able give around 6 to 12 eggs while a poor responder many result in only 1 to 6 eggs. However, even if the quantity of the eggs is poor but the quality is good there is a high chance of IVF success. Women who have poor ovarian reserve are usually poor ovarian responders too. Hence a woman with poor ovarian reserve will need extra stimulation for maturing the eggs in her ovaries. As long as a woman has eggs in her ovaries she can conceive. As women approach menopause and begins the initial symptoms, it is quite natural to get a little apprehensive about one’s fertility. However, there are still some eggs in the ovaries and it is no too late to get pregnant.

  • I am new at follicle counting. With large multiple follicles, find it difficult to keep track of the ones I have counted. Is there an easy method? Also does it make a difference if you count the follicles incorrectly

  • Sir………you are awesome and your knowledge inspiring……..let there be spread of good knowledge for the betterment of our patient

  • I am really glad that you were able to film during the appointment. It was cool to see the interpreter working. I am going into my junior year of the program and will start interpreting and I am petrified. Lol

  • Spouse had hers on day 3… the ivf center doesn’t believe in DHEA but she has been taken long for 17 weeks now… about to start IVF cycle….

  • Sir Mera amh level 10.10 he or muje period regular nahi ate davai see ate he ya pragnancy treatment chalu hi to ate he or pahele spotting jasa chalu hota he or phir have blood clots ate he Mera ivf treatment chalu he hyperplesia hota he kyo