Thursday, August 31, 2006

What's the Deal with Antral Follicles?

I’m back! Let’s face it, if I stayed away until I wasn’t whiny, I’d never write again. Thanks for all of your encouragement of my super ovaries.

But are they really super?

I just read a very interesting page on antral follicle counts and what they might tell you about your success chances for IVF. You have to read down to the middle to end of the page to get to the good stuff. Basically, there was a study done proposing that the number of antral follicles you have at the beginning of your cycle (when they do the baseline ultrasound) predicts how well you will respond to stimulation and how successful you might be overall with IVF. Forgive me if I’m summarizing this poorly—it’s better to read the article for complete details. This also already may be obvious to those of you pros out there. Still, I was interested to see what my count of 8 antral follicles on my first monitoring day meant. There is a handy chart (it reads better on the link):

Total number of antral follicles/ Expected response and chances for success
Less than 4 Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should seriously consider not attempting IVF at all. Rare pregnancies if IVF attempted.

4-7 Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation.
Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.

8-10 Somewhat reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy as a group.

11-14 Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually good. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group only slightly reduced compared to the "best" group.

15-26 Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product.
Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation.
Best pregnancy rates overall as a group.

Over 26 High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product.
Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group have egg quality issues and lower chances for pregnancy.

So, I’m seeming to be a little blow average according to this. Are my ovaries are just C- students? And here I thought they would make the honor roll!

What do you all think? 15-26 antral follicles seems crazy high for “normal.” Did anyone out there have numbers like that?

I think this is like trying to read tea leaves to predict your pregnancy likelihood.


Hopeful Mother said...

That is very interesting. I didn't even know they were counting antral follicles when I went in for my first scan. Now that I've been through 1 IVF I know what to ask the next go round...

I had 13 follicles at my last scan before retrieval and they retrieved 7 eggs, 6 mature. I was a little concerned that I wasn't responding well enough, but really, I was only on 150IU of Repronex (FSH/LH) daily, so that was a pretty decent response. Plus I was really happy not to be sore in the ovaries or worry about OHSS. Of course, it would have been better with a BFP!

We are doing 225IU next go-round, but more stims can't give me more follicles, but it could give me more mature eggs in the existing follicles, which would increase the chances of success (hopefully).

Every case of OHSS I've read about, the woman has had more than 20 follicles, and usually it does not result in a lot of really good eggs, so it really is about quality and not quantity (as long as you're near normal I wouldn't worry too much!)

Plus, IVF cycles are a little bit like a mad scientist experiment... they don't know how you will react to stims until you've done one cycle. Sometimes we're lucky the first time, sometimes we're not.

Wishing you all the best. Thanks for showing us this info.

JennyK said...

All that matters is the final exam. Forget about the midterm grade.

Lisa said...

Emmie - My antral count was also 8. I did the Follistim regimen, not Lupron since I had issues with Clomid (which acts the same). I was told 8 is average, whatever that means. I had to be stimulated at the hightest dose of Follistim for almost 2 wks just to retrieve 7 good eggs. I don't know if the antral count played a part.
I understand all too well what you're going though. Feel free to read about my experience at And I'd be happy to discuss the steps with you further if you have questions. Good luck.

deanna said...

I don't know much of anything about IVF, but I would say that since you've seen an increased number of follicles with each ultrasound, that should be a good thing, right? Hopefully they'll just keep popping up and wind up in the honor roll yet!

Motel Manager said...

I tried to comment on this before, but I'm not sure it worked. If it did and you just don't want the comment, feel free to ignore! :)

I've always had 24-31 antrals, and look where it's gotten me - nowhere. I read that article you cite when I first got going, and I was so fired up. But I have since heard or read (I forget which) that while it is true that antrals predict your response to stims pretty well, the association with pregnancy rates is NOT there to the extent that that article states. And that would certainly seem true with me.

I know of so many people who have had numbers similar to yours and who have succeeded. I would feel confident. Sure, it'd be great if a few more pop up, but it is definitely quality, not quantity.

Jo said...

Every cycle can be different.

First cycle had 15-20 antral, had 13 retrieved, ended up with a BFP- twins.. 1 ectopic, the other blighted in utero. (mild OHSS)
Second cycle had only 10 antral.. had 9 ret, only 3 made it to blast. BFP- I have a baby boy from that.
Third cycle. antral count over 20. 15 ret. 3 blast. BFP-Chem. (mild ohss)
Fourth cycle, antal over 26. 22 retr. 3 blast. BFN. I was ready for OHSS, drank ONLY gatorade and V8. NO water ar all. Was able to control that severe OHSS.

I also have PCOS, but not the symptoms. I tend to be underweight, no extra hair, etc. I have been on metformin. I am now on 2000 mg a day..*gag*

I don't think it can predict a pregnancy, just more of a response. Antral counts can tell more about what to expect for that cycle. I do think doctors use that and FSH readings to try and get a protocol together. I was on 150iu of Gon@lF and 75iu of Menop@r a day, dropping to just Menop@r for the last few days of stims. I also stimmed fast. Triggered after 8 or 9 days max.

It really is more about the quality then the quantity. I do agree that too many follicles can affect the quality. It also will raise e2 levels and if you do hyperstim, then they can delay the transfer.

Like Hopeful said, the first cycle is a mad scientist experiment, everyone responds differently and you can respond different ways in other cycles.

8 to 10 will be fine if the quality is good.

Hope I didn't ramble too much!

Best of luck to you : )