Abstract
Infertility has emerged as a growing global health concern, affecting nearly 10–15% of couples of reproductive age. Assisted reproductive technologies (ART), particularly in vitro fertilization (IVF), offer significant hope for achieving pregnancy, yet their success rates vary widely depending on several biological and clinical factors. Among these, ovarian reserve assessment plays a central role in predicting treatment outcomes. Antral follicle count (AFC), measured by transvaginal ultrasonography during the early follicular phase, is one of the most widely used and non-invasive methods for estimating ovarian reserve. AFC reflects the number of small antral follicles present in the ovaries and serves as an indirect marker of the remaining primordial follicle pool.
The predictive value of AFC in IVF lies in its ability to estimate ovarian responsiveness to controlled ovarian stimulation, determine the number of oocytes retrieved, and influence overall clinical pregnancy rates. Studies between 2016 and 2022 have consistently highlighted that women with higher AFC values generally produce more oocytes and embryos of better quality, which translates into higher implantation and pregnancy success. Conversely, women with low AFC often experience poor ovarian response, higher cycle cancellation rates, and reduced chances of live birth. This makes AFC an important tool not only for counseling patients but also for customizing stimulation protocols, optimizing medication dosages, and setting realistic expectations regarding IVF outcomes.
Despite its utility, AFC is not without limitations. Variability in ultrasound techniques, inter-observer differences, and overlapping values across age groups can sometimes reduce its accuracy. Furthermore, conditions such as polycystic ovary syndrome (PCOS) can lead to an artificially elevated AFC that may not necessarily predict successful outcomes. Therefore, many researchers recommend combining AFC with biochemical markers such as anti-Müllerian hormone (AMH) to improve predictive precision. Still, AFC remains a cost-effective, accessible, and widely accepted first-line test in routine fertility practice.
The clinical significance of AFC extends beyond prediction; it also aids in risk stratification. Women with high AFC are at increased risk of ovarian hyperstimulation syndrome (OHSS), while those with low AFC may face cycle failure. This dual role underscores its importance in both maximizing success and minimizing complications. Recent research emphasizes integrating AFC into individualized IVF protocols, ensuring safer and more effective treatments.
Ultrasonic antral follicle count remains a valuable and reliable predictor of IVF success. It provides critical insights into ovarian reserve, response to stimulation, and likelihood of pregnancy. When used alongside other clinical and hormonal markers, AFC enhances personalized fertility care and contributes to improved ART outcomes. Future research should focus on refining imaging techniques and standardizing measurement protocols to further strengthen its predictive accuracy.