The AFC ultrasound examination in the diagnosis of female infertility – the most important information

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The AFC ultrasound examination belongs to the group of tests used to evaluate the ovarian reserve. The ovarian reserve is otherwise known as the reproductive potential of the ovaries, i.e. the number of follicles that are able to grow and transform into a mature egg. What is the AFC test in the diagnosis of female infertility? What other test is done for ovarian infertility?

The causes of female infertility

Infertility is a disorder that affects both women and men. In both cases, this is a serious problem, especially when the couple is trying hard for a baby. In the case of female infertility, about ⅓ of cases result from hormonal disorders and abnormal ovulation. The most common causes of infertility in women are:

1. pelvic inflammation and scarring changes in the fallopian tubes – this is a group of inflammatory diseases that affect the upper part of the female reproductive system. Inflammation often causes damage to the fallopian tubes, which in turn causes infertility. The risk of infertility in women increases with the severity of the infection and the number of relapses;
2. endometriosis – is a chronic disease that reduces fertility in 96%. This disease is characterized by the presence of the endometrium, i.e. the lining of the uterine cavity outside it. Endometriosis outbreaks can appear in the fallopian tubes, on the ovaries or on the peritoneum, but sometimes they also go to the intestines or lungs. ;
3. polycystic ovary syndrome – is one of the most frequently diagnosed endocrine diseases, as it affects approximately 5-15% of women of reproductive age. This disease involves many other metabolic conditions, such as insulin resistance. This disease results in an overproduction of androgens, which ultimately causes ovulation disorders and infertility;
4. uterine fibroids – these are benign tumors in the uterus that may be a causative factor in infertility. Uterine fibroids can lead to miscarriage or premature miscarriage;
5. polyps – these are flat, oblong structures made of the mucosa that can appear in any part of the body. Polyps in the womb can cause heavy menstrual bleeding and infertility;
6. defects of the uterus and its cervix – congenital abnormalities in the structure of the uterus lead to fertility disorders, recurrent miscarriages and other obstetric disorders;
7. Turner syndrome – is an inherited genetic disease that occurs only in women and is caused by the absence or incomplete development of the X chromosome. 80-90% of girls with Turner syndrome suffer from ovarian hypoplasia, which causes delayed puberty, amenorrhea and infertility;
8. diseases of the pituitary gland, adrenal glands and thyroid gland – these are diseases that are associated with endocrine disorders. Hormonal disorders are one of the main causes of infertility in women. Normally, hormonal regulation enables a woman to become pregnant;
9. sexually transmitted diseases – not all sexually transmitted diseases cause infertility. Sexually transmitted diseases that adversely affect a woman’s fertility include gonorrhea and chlamydiosis;
10. underweight and obesity;
11. alcohol abuse;
12. immune system disorders;

Learn about treatments for fertility problems. Read: Infertility Treatment Methods

AFC test and ovarian infertility

The AFC test is an important test that assesses the number of antral follicles. Anthral follicles are follicles in the ovaries, 2-8 mm in diameter, which are ready to grow under the influence of natural gonadotrophins produced by the pituitary gland. In the course of growth, antral follicles become dominant, and the eggs mature in them.

Ovarian infertility diagnosed during the AFC study is a type of infertility associated with disorders at the ovarian level. Among the reasons that can cause a reduction in the so-called ovarian reserve, the presence of cystic changes, treatments in the area of ​​the smaller pelvis, or even excessive cigarette smoking are indicated. In ovarian infertility, the biggest problem is poor ovulation, which greatly reduces the chances of getting pregnant.

What tests are performed if infertility is suspected? Check: Diagnosis of infertility in women – what tests should be performed?

Ovarian reserve assessment – the aim of the AFC study

AFC is the basic ultrasound parameter in the assessment of female fertility. This examination is most often performed on the first day of menstruation. This is due to the fact that the number of antral follicles in the ovaries during menstruation is a very sensitive indicator of a patient’s reproductive capacity. The AFC test in the first days of menstruation is the basic element in assessing a woman’s fertility. If the number of antral follicles is 2-3 on day 2-3 of menstruation, serious problems with getting pregnant can be expected.

It happens, however, that the number of antral follicles is too large. It happens when you can count even several dozen in one gonade. Such a symptom is a sign of polycystic ovary syndrome, which is also associated with problems with becoming pregnant. The optimal number of antral follicles is from a few to a dozen or so per one ovary.

Are infertility tests expensive? Read: How much do women’s fertility tests cost and where to do them?

What affects the ovarian reserve?

The ovarian reserve is the reproductive potential of the ovaries. Each woman is born with a certain reserve of approximately 1,2 million primary cells, i.e. oocytes. From then on, the number of oocytes continues to decline, never increasing. During sexual maturation, the number of oocytes is only 300-500 thousand. Then most of the oocytes are degraded and only about 400-500 of them remain.

In each menstrual cycle, one of the oocytes ovulates, so the older a woman gets, the more difficult it is to get pregnant. The ovarian reserve largely depends on the age of the woman. Other reasons that lower the ovarian reserve include:

1. ovarian diseases, gynecological operations and cysts – all gynecological procedures are associated with the risk of damage to the ovary or fallopian tube, which negatively affects the ovarian reserve;
2. nicotine and excessive cigarette smoking;
3. physical inactivity;
4. genetic or autoimmune conditions, including hypothyroidism, Hashimoto’s disease, Addison’s disease, lupus erythematosus, rheumatoid arthritis and diabetes;
5. viral infections;
6. chemotherapy and radiotherapy.

The ovarian reserve begins to decline from around the age of 20, and its clear decline is especially noticeable after a woman turns 30. However, recent studies have shown that lifestyle and diet changes have prevented the ovarian reserve of modern women from dropping so drastically. This means that declining ovarian reserve is not the most important cause of infertility. Endometriosis, blocked fallopian tubes or polycystic ovary syndrome are much more serious problems when trying to get pregnant.

For more important information about infertility, see Infertility

The specifics of the AFC study

The AFC examination belongs to ultrasound examinations. This is an ultrasound scan that is performed at the beginning of the menstrual cycle, preferably on the second day of your period. If the number of follicles during your period is less than 4, it will be difficult for you to get pregnant. Too high a result is also worrying as it indicates polycystic ovary syndrome. The advantage of the AFC assessment is that it can be performed during the initial ovarian assessment at the first visit to the doctor.

What gynecological examinations should be performed? Check: Gynecological examination

Other tests to assess the ovarian reserve

The diagnosis of female infertility, which aims to assess the ovarian reserve, also includes other tests that should be performed by every woman who has been trying to get pregnant for a long time without positive results. The tests that should be performed in this case, apart from the AFC ultrasound examination, include:

1. AMH test – is the basic, independent laboratory parameter used in the assessment of a woman’s fertility. The concentration of AMH is measured from the collected blood serum. A low AMH result indicates a decreased ovarian reserve, while a high result may indicate the occurrence of hyperstimulation syndrome. A result of less than 0,7-1 ng / l shows a low ovarian reserve. However, it should be remembered that a single low serum AMH result in women does not mean that she is unable to become pregnant, especially in young women. It’s worth noting that women with low AMH menstruate. And those who had a low level of this parameter throughout their lives may have children.
2. FSH test – when assessing the ovarian reserve, the level of FSH in the blood serum is also determined. This test should be performed on the second or third day of the menstrual cycle. A result above 15 mIU / ml indicates a lowered or low ovarian reserve, and also adversely affects the chance of getting pregnant, the number of properly growing eggs and the proper response of the ovaries to external stimulation. It is difficult to say unequivocally what result is considered alarming. However, it is assumed that results below 12 mIU / ml are normal, while higher results may cause infertility in women. If the FSH test result exceeds 25 mIU / ml, the probability of becoming pregnant is very low.

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