Causes & Treatment

Antral follicle count and fertility over 35 – a clinic answers your questions

Kristina Lopez in partnership with Clínica Tambre  |  31 Jul 2023


What’s a normal antral follicle count for women aged 35 – and when should you worry? If you are over the age of 35 and feeling overwhelmed with fertility planning, we are here to help make things easier to navigate starting with the epicenter of your fertility: the antral follicle.

We’ve partnered with Clínica Tambre, a renowned fertility clinic based in Madrid, to create this super-helpful Q&A which answers your most asked questions about this crucial stage in your life and your reproductive health. The clinic has over 45 years of experience and consistently achieves the highest success rates in Spain and throughout all of Europe. They are committed to providing the best patient-centred experience with state-of-the-art technology and medical facilities to help women explore their fertility treatment and egg donation options. 

TBR readers can connect here with their wonderful team for the best in-patient-centred experience in Spain right now.

Q&A: Understanding antral follicle count at age 35

What are antral follicles?

Antral follicles are small, fluid-filled sacs, or follicles, in the ovaries that contain immature eggs. In people with ovaries, the quantity and quality of eggs decline with age, particularly after the age of 35. Therefore, measuring the number of antral follicles (known as antral follicle count) becomes crucial to assess a woman’s ovarian reserve.

These antral follicles are in their final stage of development and are sensitive to follicle-stimulating hormone (FSH), meaning they are the most likely to advance in their development to become pre-ovulatory follicles. Only one antral follicle will fully develop each month to release a mature egg from the ovary during ovulation. 

What test is used to measure the number of antral follicles?

A vaginal ultrasound is the best way to accurately assess the antral follicle count (AFC). A small ultrasound probe is inserted into the vagina to visualize the ovaries from multiple angles. Then, the number of antral follicles in each ovary (typically appearing as small black circles) can be counted.

This helps you and your clinic understand the potential for successful egg development and enable the clinic to tailor fertility treatments with all options such as egg donation.

What is a normal antral follicle count by age, and what is considered a low antral follicle count?

We know that female fertility declines with age, but it’s important to know how the antral follicle count also drops as women get older, too. Here is a guide to the average normal antral follicle count, by age:

  • 25 to 34 years: 15 is considered a normal AFC for this age group. Anything less than 5 is considered low, whereas anything above 15 is high.
  • 35 to 40 years: 9 is considered a normal AFC for this age group. Anything less than 3 is low, whereas more than 12 is considered high.
  • 41 to 46 years: Women start approaching menopause slowly during this time, meaning fertility is at its lowest. 4 is considered normal AFC at this age. Anything less than 3 is a low reserve, whereas anything more than 10 is a high reserve.

It’s important to know that your antral follicle count can vary each month during your menstrual cycle. You’ll usually have an AFC performed in the early follicular phase, and talking through your personal test results with your doctor will help you get the clearest picture of your outcome and how to move forward.

What is a good antral follicle count for IVF?

For an IVF cycle, your ovaries are stimulated to produce several mature follicles at the same time. The higher the number of antral follicles, the higher the number of eggs that can be expected to be collected during retrieval. If you’re over the age of 35 and have a low AFC, you’ll likely need higher doses of medication, and cancellation of an IVF cycle is generally more common.

Whilst everyone is different, Clínica Tambre suggests that an antral follicle count between 10 and 15 is what doctors generally look for to indicate a positive outcome.

improve antral follicle count

What does it mean if my antral follicle count is lower than average for my age?

If your antral follicle count is lower than the average expected for your age, it may indicate a reduced ovarian reserve. While this news may feel worrying, it doesn’t mean you are infertile and that getting pregnant is impossible. Each woman is unique, and other factors like egg quality, hormone levels, overall health, uterine health, and more can also influence your fertility.

What are the recommended next steps if I have a lower antral follicle count?

Whilst there is no proven way to increase your antral follicle count, making certain lifestyle and dietary changes like avoiding smoking and alcohol, eating plenty of fruit, vegetables and healthy fats, and exercising when you can, can all work together to help support your fertility.

Talking to your fertility clinic is also absolutely key. The empathetic team of fertility specialists at Clínica Tambre are happy to help ease your concerns by analyzing all the factors that influence successful change and look for possibilities to increase the chance of a successful pregnancy. They are dedicated to offering a beautiful and supportive setting where you can openly express your concerns and questions. For women with a lower AFC, they provide advanced fertility treatments, such as in vitro fertilization (IVF) and egg donation, to increase the chances of a successful pregnancy.

When could egg donation play a role in treatment?

The decision to use donor eggs is a very personal one, and there is no right or wrong here. If you’ve got a low or diminished ovarian reserve and are over 35, opting for IVF with donor eggs can bring a renewed sense of hope, greatly improving the chances of conception. Clínica Tambre’s comprehensive egg donation program is available for women seeking an alternative pathway to motherhood, with a diverse pool of healthy donors and an expert team to ensure you feel confident and comfortable throughout the process.

What can I do, right now?

If you’re looking for guidance and a better understanding of the fertility planning process, the team at Clínica Tambre places the utmost importance on understanding every patient in every step of their fertility journey.

They are fully prepared to ensure a seamless and smooth transition process should you choose to switch to their care.

TRB readers can connect with the wonderful team at Clínica Tambre for the best in-patient-centred experience in Spain right now.

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