Sunday, March 29, 2009

Antral follicle count and IVF success

When I had my fluid ultrasound (FUS) back in December '08, and then received my records a few weeks later, I totally overlooked the fact that they DID record my antral follicle count that day. Originally, I guess I missed it in the sea of accronymns that was my doctor write-up. So... drum roll... my antral follicle count on my one existing ovary was "15+". I don't know if that means they stopped counting at 15 or if they counted approximately 15. Either way it's indicative of PCOS. This isn't the first time I've had a doctor say I have a PCO ovary - all my OBs confirmed this as well. While your antral follicle count does vary from cycle to cycle, it's still nice to have something to go off of for now.

Below is some info I found on the web in regards to what your antral follicle count is and what is a "good" count. The Advanced Fertility Center of Chicago has an entire page dedicated to this topic and below is their chart on what are some "general" guidelines. To read their information in it's entirity, go here.

Total number of antral follicles
Expected response to injectable ovarian stimulating drug (FSH product)
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.
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.
Somewhat reduced count.
Higher than average rate of IVF cycle cancellation.
Slightly reduced chances for pregnancy as a group.
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.
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.

Going off the above, it tells me it might be nice to know in the future if I really do have +15... as it seems that might be a bad thing. For now, I won't be overly concerned. I'm just glad the one ovary is still working!

I also came acoss a medical journal article from November 2006, titled "Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization," concluded that "AFC (antral follicle count) performs well as a test for ovarian response being superior or at least similar to complex expensive and time consuming endocrine tests. It is therefore likely to be the test for general practice.

They reported the following, regarding antral follicle counts in relation to follicles AFTER stimulation: "We defined a 'poor' ovarian response as less than 6 oocytes after ovarian hyperstimulation in an IVF treatment and a 'hyper' response as more than 20 oocytes after such an IVF treatment. Among women undergoing in vitro fertilization, the chances of a live birth are related to the number of eggs fertilized, presumably because of the greater selection of embryos for transfer. The low success rate when only two eggs were fertilized reflects the lack of choice among embryos for transfer. We have in our laboratory the experience that we have an overall 50–60% chance of fertilization. Taken this together, at least 6 oocytes are required for three or more fertilized eggs. We defined a hyper response when there were > 20 oocytes. This was based on the knowledge that the pregnancy rates do not increase when > 20 oocytes are retrieved. Moreover, such cases have a significant risk of a severe OHSS."

Guess we'll just wait and see what my antral follicle count is at my next ultrasound, which most likely won't be until right around the time I start my IVF cycle (TBD).

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