AFC / FSH...?
Thu, 2007-09-13 14:26
Again, I would love some clarification on a couple things.
AFC, Antrafollicle count. When is this done and why? Is there a difference when done with a clomid challenge, for IVF purposes, or just checking by itself for POF purposes? Why is this done sometimes with and sometimes without an FSH test? What are the #'s you are looking for when doing an AFC, what is low, high?
FSH, Follicle Stimulating Hormone. If it is high once, will you retest and do an IVF at a later date if the count comes down into acceptable ranges? When is this an indicator of POF and when do you rely on an AFC ultrasound? Do you always check both FSH and AFC when doing a clomid challenge?
Thanx for clearing the fog on this topic.
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Hello Spence,
All of the tests that you mention (AFC, FSH, etc) are all measurements of a woman's "ovarian reserve" - whether a woman's ovaries are functioning well or whether there may be an issue with the number of eggs and the quality of the eggs.
The easiest and most "established" method of determining ovarian reserve is the Day 3 FSH test. Day 3 is chosen for standardization purposes. It is generally considered abnormal if it is high (>10) and the higher it is, the worse the ovarian reserve. The level does fluctuate monthly which can be confusing for patients - "why is it normal now when it was abnormal last month?" However, studies show that the highest it ever has been is predictive of how a patient will do in the future.
The antral follicle count is an ultrasound count of the small resting follicles that are in the ovaries. The higher the count, the better the ovarian reserve. Menopausal womens' ovaries have no antral follicles while menstruating women will have a variety of AFC counts. It used to be done on Day 3 but more recent studies demonstrate that it can be done at any time during the menstrual cycles.
Premature ovarian failure (POF) represents a small subset of women (1%) who go into menopause at an age of <40. It is important to note that a 42 year old women who is having menstrual cycles with a high FSH level does not have POF. Menopause is the cessation of periods indicating that there are no eggs left.
The Clomiphene Challenge Test is another method of testing ovarian reserve that involves measureing FSH levels in a cycle in which the patient uses Clomiphene - an oral fertility medication. I personally rarely use this test as I don't find that it adds little to the clinical picture but some other doctors use it routinely. It really depends on physician preference.
In terms of when these tests are done, I perform a Day 3 FSH and an AFC on essentially every patient I see for fertility. I feel that it is important to use this information, in conjunction with the patient's age, to determine whether there may be an egg issue in their fertility problems.
I hope this helps clear the fog, take care,
Dr.Jason Hitkari, Genesis Fertility Centre
Thank you Jason,
What number would you like to see? We have discussed recently how it is difficult to tell if a woman is fertile with a fertility work up, but you can predict if she is infertile or going to have challenges conceiving naturally or with IVF.
What would be consider to be less than optimal AFC? Is there a minimum number to move forward with an IVF?
No problem.
I will try and answer these questions.
When is it done?
For the AFC, the Antral Follice Count, it is generally done before someone starts treatment with IVF or even Clomid. It really gives us a sense of whether the patient's ovaries are acting "old" or "young". It also allows us to choose an appropriate dose of FSH medicine for those women who are doing IVF.
Many centres do an AFC on the third day of menstrual flow. However, newer research shows that an AFC can be done at any day in a woman's cycle.
Is there a difference when the AFC is done with a Clomid Challenge Test?
No. When a doc orders both an AFC and a CCT, he is trying to use two different methods to determine whether a patient has good ovarian reserve. The CCT should not impact the AFC.
What numbers are you looking for in an AFC?
In essence, the higher the antral follicle count, the better a patient's ovaries will respond to medications. A poor antral follicle count would be <8 (combining both ovaries count). What is considered a "normal" AFC depends on the patient's age.
Would you wait for a day 3 FSH to come down before starting IVF?
Reserach shows that a patient will respond to medications based on the highest FSH that has been recorded. So, for example, a patient's Day 3 FSH may be 14 one month and 8 the next. That seems encouraging but studies show that this patient's ovaries will respond according to the 14 not the 8.
Do you always check both FSH and AFC when doing a CCT?
No. An AFC and a CCT are really two different tests that can be done during the same cycle. I personally don't use the CCT that often and rely primarily on Day 3 FSH and AFC.
Hope this helps,
Take care,
Dr.Jason Hitkari, Genesis Fertility Centre
Dr. Jason Hitkari
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