Pelvic Ultrasound/Antral Follicle Count

 A pelvic ultrasound is a test that is useful in many circumstances when a woman is seeking evaluation and treatment of infertility. Since a transvaginal ultrasound provides a close-up assessment of the pelvic organs, this is the approach that we will most often utilize. For women with irregular menstrual cycles or abnormal bleeding, a pelvic ultrasound can be helpful in determining which medication(s) to administer for cycle regulation. Most frequently, we will obtain a pelvic ultrasound to evaluate your response to medications that stimulate the ovaries in the context of ovulation induction.

Before a stimulation cycle is begun, we recommend undergoing a baseline ultrasound, usually performed on day 2 or 3 of your cycle. This helps to ensure that there are no residual cysts from your previous cycle (i.e. the ovaries are in a baseline state) and allows our physicians to perform an important evaluation of your ovaries—the antral follicle count (AFC).

Each woman possesses a finite number of follicles in each of her ovaries dating back to before birth, and a certain number of these follicles are brought to the forefront each month. Since these small (between 3 to 10 mm) early follicles are visible via ultrasound early in the menstrual cycle, the AFC is helpful in selecting a specific stimulation protocol for each patient. Multiple articles have demonstrated that the AFC is perhaps the best predictor of patient response to medication (i.e. the number of mature follicles); research has also suggested that an AFC greater than or equal to 11 follicles was a significant predictor of live birth following in vitro fertilization (IVF) cycles (Maseelall PB, Fertility & Sterility, April 2009).