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AFC scan antral follicle count ultrasound fertility assessment London Pregnancy Clinic

What Is an AFC Scan and What Does Your Antral Follicle Count Mean for Your Fertility?

Written by LPC Editorial Team on 19. March 2026. Posted in Blog, Fertility, Scans.

What Is an AFC Scan and What Does Your Antral Follicle Count Mean for Your Fertility?

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What Is an AFC Scan?

An antral follicle count (AFC) scan is a specialised transvaginal ultrasound examination that measures the number of antral follicles visible in both ovaries. Antral follicles are small, fluid-filled sacs measuring 2-9mm in diameter, each containing an immature egg. These follicles appear as dark, roughly circular areas on the ultrasound screen and represent your ovarian reserve – essentially, the number of eggs remaining in your ovaries.

The AFC scan is considered one of the gold standard methods for assessing ovarian reserve, alongside hormone blood tests such as anti-Müllerian hormone (AMH). Unlike blood tests that can fluctuate, the AFC provides a direct visual assessment of your ovaries’ current state. This transvaginal scan is typically performed during the early follicular phase of your menstrual cycle, usually between days 2-4, when hormone levels are at their baseline.

The procedure itself is straightforward and similar to other transvaginal ultrasounds. A small ultrasound probe is gently inserted into the vagina, providing clear, detailed images of the ovaries. The sonographer can then count the visible antral follicles in each ovary, providing an accurate assessment of your ovarian reserve.

Understanding Normal AFC Ranges

Antral follicle count results are typically categorised into different ranges that indicate varying levels of ovarian reserve. Understanding these ranges can help you interpret your results and discuss treatment options with your fertility specialist.

Low AFC (3-6 total follicles): Indicates diminished ovarian reserve and may suggest a reduced response to fertility treatments.
Normal AFC (7-15 total follicles): Represents a healthy ovarian reserve with good potential for natural conception and fertility treatment success.
High AFC (16-24 total follicles): Suggests excellent ovarian reserve but may increase the risk of ovarian hyperstimulation syndrome during fertility treatments.
Very high AFC (25+ total follicles): May indicate polycystic ovary syndrome (PCOS) and requires careful management during fertility treatments.

It’s important to note that these ranges can vary slightly between different clinics and medical guidelines. The RCOG recognises that individual circumstances vary, and your fertility specialist will interpret your results in the context of your age, medical history, and other fertility factors. A pelvic scan may also be recommended to assess the overall structure and health of your reproductive organs.

Why AFC Matters for Your Fertility

Your antral follicle count provides crucial information about several aspects of your fertility potential. Understanding these implications can help you make informed decisions about family planning and treatment options.

Firstly, AFC serves as a predictor of ovarian response to fertility medications. Women with higher AFCs typically produce more eggs during ovarian stimulation, whilst those with lower counts may require adjusted medication protocols or different treatment approaches. This information is invaluable for fertility specialists planning IVF cycles or other assisted reproductive treatments.

The AFC also helps predict the likelihood of pregnancy success with various fertility treatments. Research indicates that women with very low AFCs may have reduced live birth rates, whilst those with normal to high counts generally have better prognosis. Additionally, AFC can help identify women at risk of ovarian hyperstimulation syndrome (OHSS), allowing specialists to adjust treatment protocols accordingly.

For women considering egg freezing, AFC provides essential information about the optimal timing and expected outcomes. A higher AFC suggests that more eggs can potentially be retrieved and frozen, improving future fertility options. This assessment is particularly valuable for women who wish to preserve their fertility for personal or medical reasons.

When Should You Have an AFC Scan?

Several circumstances may warrant an AFC scan as part of your fertility assessment. Understanding when this test is recommended can help you seek appropriate care at the right time.

Women experiencing difficulty conceiving after six months of trying (if over 35) or twelve months (if under 35) should consider comprehensive fertility testing, including an AFC scan. This assessment provides valuable baseline information that can guide further investigations and treatment decisions.

AFC scans are also recommended before starting any fertility treatments, including IVF, intrauterine insemination (IUI), or ovarian stimulation. The results help fertility specialists tailor medication doses and treatment protocols to your individual needs, optimising both safety and success rates.

Women with irregular menstrual cycles, suspected PCOS, or family history of early menopause may benefit from AFC assessment. Additionally, if you’re considering egg freezing or have concerns about your fertility potential, an AFC scan can provide valuable insights to inform your decisions. The scan works well alongside follicle tracking scans during treatment cycles.

The AFC Scan Procedure: What to Expect

Understanding what happens during an AFC scan can help alleviate any anxiety and ensure you’re properly prepared for the appointment. The procedure is straightforward, typically taking 15-20 minutes to complete.

You’ll be asked to undress from the waist down and lie on an examination couch with your knees bent and feet in stirrups, similar to a cervical screening position. The sonographer will insert a thin ultrasound probe, covered with a protective sheath and gel, gently into your vagina. This provides clear, detailed images of your ovaries on the ultrasound screen.

The sonographer will systematically examine both ovaries, counting the visible antral follicles and measuring your ovaries’ size and structure. You may feel slight pressure during the examination, but the procedure shouldn’t be painful. Many women find it helpful to empty their bladder before the scan for comfort.

Results are typically available immediately after the scan, and the sonographer or specialist can discuss the findings with you straight away. You’ll receive a detailed report that can be shared with your GP or fertility specialist for further treatment planning. This comprehensive assessment complements other fertility investigations you may have undergone.

Factors That Can Affect Your AFC

Several factors can influence your antral follicle count, some of which are modifiable whilst others are not. Understanding these factors can help you interpret your results and potentially improve your fertility outcomes.

Age is the most significant factor affecting AFC, with counts naturally declining as women get older. This decline accelerates after age 35, with more rapid decreases typically occurring in the early forties. However, there’s considerable individual variation, and some women maintain good AFCs longer than others.

Hormonal contraceptives, particularly the combined oral contraceptive pill, can temporarily suppress AFC measurements. If you’re taking hormonal contraception, your specialist may recommend stopping it for 1-3 months before the AFC scan for more accurate results. Other factors including smoking, certain medications, previous ovarian surgery, and medical conditions like endometriosis can also impact your AFC.

Lifestyle factors such as stress, poor nutrition, excessive exercise, and environmental toxins may negatively affect ovarian reserve. Whilst you cannot change your age or genetic factors, addressing modifiable risk factors may help optimise your fertility potential and overall reproductive health.

AFC Results and Treatment Planning

Your AFC results play a crucial role in determining the most appropriate fertility treatment approach for your individual circumstances. Fertility specialists use this information alongside other factors to develop personalised treatment plans.

For women with low AFCs, treatment protocols typically involve higher doses of fertility medications or alternative approaches such as natural cycle IVF or donor egg treatment in some cases. The focus shifts to maximising the quality of available eggs rather than quantity, and specialists may recommend proceeding with treatment sooner rather than later.

Normal AFC results generally indicate good treatment prospects, with standard stimulation protocols likely to be effective. Women in this category often have multiple treatment options available and may choose to delay treatment if desired, though age-related factors should still be considered.

High AFCs require careful management to prevent ovarian hyperstimulation syndrome. Treatment protocols typically use lower medication doses, close monitoring throughout the cycle, and sometimes alternative trigger medications. Women with very high AFCs and suspected PCOS may need additional assessments and specialised treatment approaches. Follicle tracking scans become particularly important during treatment cycles.

AFC and Age: Understanding the Connection

The relationship between age and antral follicle count is one of the most important aspects to understand when interpreting your results. This connection has significant implications for fertility potential and treatment planning.

Women are born with all the eggs they’ll ever have, approximately 1-2 million at birth. This number continuously declines throughout life, falling to around 400,000 at puberty and continuing to decrease at an accelerating rate. By age 37, most women have only about 25,000 eggs remaining, with this number dropping to approximately 1,000 by age 51.

AFC generally correlates with this natural decline, but there’s considerable individual variation. Some women in their late thirties may have AFCs similar to women in their twenties, whilst others may show earlier declines. This variability makes individual assessment crucial rather than relying solely on age-based predictions.

Understanding your personal AFC in relation to your age helps set realistic expectations for treatment outcomes. A 35-year-old with a high AFC may have better treatment prospects than a 30-year-old with a low AFC, highlighting the importance of individualised assessment and counselling throughout the fertility journey.

Limitations and Considerations of AFC Testing

Whilst AFC scans provide valuable fertility information, it’s important to understand their limitations and what they cannot tell you about your reproductive potential.

AFC primarily indicates quantity rather than quality of eggs. A high antral follicle count doesn’t guarantee that the eggs are chromosomally normal or capable of developing into healthy embryos. Egg quality is more closely related to age, and even women with low AFCs can achieve pregnancy with good-quality eggs.

The scan also cannot predict natural conception rates with certainty. Some women with low AFCs conceive naturally, whilst others with normal counts may experience fertility difficulties due to other factors such as tubal blockages, male factor infertility, or unexplained infertility.

AFC measurements can vary between different operators and ultrasound machines, and results may fluctuate slightly between cycles. It’s important to have scans performed by experienced sonographers using high-quality equipment. Additionally, certain conditions like ovarian cysts or recent ovulation can affect follicle visibility and counting accuracy. Your specialist will consider these factors when interpreting your results alongside other fertility assessments and your medical history.

Improving Your Fertility Outcomes

Regardless of your AFC results, there are several steps you can take to optimise your fertility potential and improve treatment outcomes. These recommendations apply to all women trying to conceive, whether naturally or through assisted reproduction.

Maintaining a healthy lifestyle forms the foundation of fertility optimisation. This includes following a balanced diet rich in folate, vitamin D, and antioxidants, achieving and maintaining a healthy weight, engaging in regular moderate exercise, and avoiding smoking and excessive alcohol consumption. These factors can positively impact both egg quality and overall reproductive health.

Managing stress through relaxation techniques, counselling, or support groups can also be beneficial. Chronic stress may negatively affect hormone levels and ovulation, potentially impacting fertility outcomes. Ensuring adequate sleep and managing underlying health conditions such as diabetes or thyroid disorders are equally important.

Timing is crucial in fertility treatment, particularly for women with low AFCs. Don’t delay seeking specialist advice if you have concerns about your fertility. Early assessment and intervention can maximise your chances of success and provide more treatment options. Remember that fertility is a complex interplay of many factors, and AFC is just one piece of the puzzle.

How the London Pregnancy Clinic Can Help

At the London Pregnancy Clinic, we understand that fertility concerns can be both emotionally and physically challenging. Our experienced team of specialist sonographers and fetal medicine consultants provide comprehensive AFC scanning services using state-of-the-art ultrasound equipment to ensure accurate, reliable results.

Our fertility screening services include detailed AFC assessments performed by specialists who understand the nuances of ovarian reserve testing. We take time to explain your results thoroughly, discussing what they mean for your individual circumstances and potential treatment options. Our compassionate approach ensures you feel supported throughout your fertility journey.

We offer flexible appointment times to accommodate your menstrual cycle timing, ensuring optimal accuracy of your AFC scan. Our detailed reports can be easily shared with your fertility specialist or GP to facilitate seamless care coordination. Additionally, we provide access to genetic counselling services if your results indicate the need for further genetic assessment or family planning guidance.

Whether you’re just beginning to explore your fertility potential or seeking a second opinion on previous results, our clinic provides a comfortable, professional environment where you can receive expert care. We’re committed to delivering accurate, timely results that help inform your reproductive health decisions with confidence and clarity.

Final Thoughts

An AFC scan represents a valuable tool in modern fertility assessment, providing crucial insights into your ovarian reserve and helping guide treatment decisions. Whilst the results can feel overwhelming, remember that AFC is just one factor in your fertility journey, and many women with varying AFCs go on to achieve successful pregnancies.

Understanding your antral follicle count empowers you to make informed decisions about your reproductive health and family planning timeline. Whether your results indicate low, normal, or high ovarian reserve, working with experienced specialists ensures you receive personalised care tailored to your unique circumstances.

If you’re considering fertility assessment or have concerns about your reproductive health, don’t hesitate to seek professional guidance. Early evaluation can provide peace of mind and ensure you have all the information needed to make the best decisions for your future. Contact the London Pregnancy Clinic today to discuss your fertility screening options and take the first step towards understanding your reproductive potential.

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Medical ultrasound equipment used for HyCoSy vs HSG fallopian tube testing comparison

HyCoSy vs HSG: Which Fallopian Tube Test Is Right for You

Written by LPC Editorial Team on 17. March 2026. Posted in Blog, Fertility, Gynaecology.

HyCoSy vs HSG: Which Fallopian Tube Test Is Right for You

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Understanding Fallopian Tube Testing

Fallopian tube testing forms an essential component of fertility assessment, helping clinicians identify potential blockages or abnormalities that may prevent conception. These diagnostic procedures evaluate whether eggs can travel freely from the ovaries through the fallopian tubes to reach the uterus, where fertilisation and implantation occur.

The two most commonly used non-surgical methods are HyCoSy (Hysterosalpingo-Contrast Sonography) and HSG (Hysterosalpingography). Both procedures involve introducing contrast medium into the reproductive system to visualise the internal structures, but they utilise different imaging technologies to achieve this assessment.

According to NHS guidelines, tubal factor infertility accounts for approximately 25-35% of female fertility issues, making accurate assessment of fallopian tube function vital for developing appropriate treatment plans.

What is HyCoSy

HyCoSy, or Hysterosalpingo-Contrast Sonography, represents a modern ultrasound-based approach to fallopian tube assessment. During this procedure, a specialised contrast medium is introduced through the cervix into the uterine cavity whilst real-time ultrasound monitoring captures detailed images of the reproductive organs.

The HyCoSy procedure utilises high-frequency sound waves to create detailed visualisations of both the uterine cavity and fallopian tubes. The contrast medium appears bright white on the ultrasound screen, allowing clinicians to observe its flow through the reproductive system and identify any areas of blockage or abnormal anatomy.

This technique offers the advantage of being radiation-free, making it particularly suitable for women who prefer to avoid X-ray exposure or who may require repeated assessments during their fertility journey.

What is HSG

HSG, or Hysterosalpingography, represents the traditional gold standard for fallopian tube assessment, utilising X-ray technology to visualise the reproductive organs. During this procedure, a radio-opaque contrast dye is introduced into the uterine cavity through the cervix, with X-ray images captured to show the dye’s progression through the fallopian tubes.

The HSG procedure provides excellent image quality and has been extensively studied and validated over decades of clinical use. The X-ray images offer exceptional detail of the uterine cavity shape and can clearly demonstrate whether the fallopian tubes are patent (open) or blocked.

HSG has traditionally been considered the first-line investigation for tubal patency assessment in many fertility clinics, with extensive research supporting its accuracy and reliability in diagnosing various reproductive conditions.

Key Differences Between HyCoSy and HSG

Understanding the fundamental differences between these two procedures can help you make an informed decision about which test may be most appropriate for your circumstances:

Imaging Technology: HyCoSy uses ultrasound waves whilst HSG employs X-ray radiation to create images of the reproductive organs.
Radiation Exposure: HyCoSy involves no radiation exposure, whereas HSG uses a controlled amount of ionising radiation.
Real-time Monitoring: HyCoSy provides real-time visualisation during the procedure, allowing immediate assessment of contrast flow.
Contrast Medium: HyCoSy uses specialised ultrasound contrast agents, whilst HSG employs radio-opaque dye visible on X-ray.
Procedure Duration: Both procedures typically take 15-30 minutes, though HyCoSy may be slightly quicker due to real-time imaging capabilities.
Equipment Requirements: HyCoSy requires specialised ultrasound equipment, whilst HSG needs X-ray facilities and fluoroscopy capabilities.

Research indicates that both procedures demonstrate comparable accuracy in detecting tubal blockages, with studies showing similar sensitivity and specificity rates for identifying fallopian tube abnormalities.

Advantages of HyCoSy

HyCoSy offers several compelling advantages that make it an attractive option for many women undergoing fertility assessment:

No Radiation Exposure: The absence of ionising radiation makes HyCoSy suitable for women who wish to avoid X-ray exposure or require multiple assessments.
Real-time Assessment: Immediate visualisation allows clinicians to observe contrast flow dynamics and make instant assessments during the procedure.
Comfortable Environment: The procedure can be performed in a standard ultrasound room rather than requiring specialised X-ray facilities.
Detailed Ovarian Assessment: Ultrasound technology allows simultaneous evaluation of ovarian morphology and other pelvic structures.
Reduced Contrast Requirements: Often requires smaller volumes of contrast medium compared to HSG procedures.
Immediate Discussion: Results can be discussed immediately after the procedure, reducing anxiety and waiting times.

Clinical studies have demonstrated that HyCoSy provides excellent visualisation of uterine cavity abnormalities and can effectively identify both proximal and distal tubal blockages with high accuracy rates.

Advantages of HSG

Despite being the more traditional approach, HSG continues to offer distinct advantages in certain clinical situations:

Established Gold Standard: Decades of clinical use and extensive research validation support HSG’s reliability and accuracy.
Superior Image Quality: X-ray technology often provides exceptional detail of uterine cavity shape and tubal anatomy.
Widely Available: HSG facilities are commonly available in most hospitals and fertility centres across the UK.
Detailed Documentation: X-ray images provide permanent, high-quality records for future reference and specialist consultations.
Cost-Effective: HSG may be slightly more cost-effective in some healthcare settings due to established protocols and equipment.
Therapeutic Benefits: Some studies suggest that HSG may have mild therapeutic effects, potentially improving conception rates in certain cases.

The RCOG recognises HSG as an effective method for assessing tubal patency, with guidelines supporting its use as part of comprehensive fertility investigations when clinically appropriate.

Potential Disadvantages and Considerations

Both procedures have specific limitations and considerations that may influence your decision:

HyCoSy Considerations:

Operator Dependency: Results may vary depending on the sonographer’s experience and expertise with the technique.
Image Quality Limitations: Ultrasound images may be affected by patient factors such as body habitus or bowel gas.
Specialised Equipment: Requires specific ultrasound contrast agents and experienced personnel trained in the technique.
Limited Availability: May not be available in all healthcare facilities compared to traditional HSG.

HSG Considerations:

Radiation Exposure: Involves controlled X-ray exposure, which some women prefer to avoid.
Contrast Reactions: Rare but possible allergic reactions to iodine-based contrast media.
Facility Requirements: Requires access to specialised X-ray equipment and trained radiological staff.
Static Images: Provides snapshot images rather than real-time dynamic assessment of contrast flow.

Procedure Experience and Comfort

Understanding what to expect during each procedure can help you prepare mentally and physically for the assessment:

HyCoSy Experience: The procedure takes place in a comfortable ultrasound room, similar to routine pregnancy scans. You’ll lie on an examination couch whilst a transvaginal ultrasound probe and small catheter are used to introduce contrast and monitor its flow. Most women describe the experience as similar to a smear test with mild cramping during contrast injection.

HSG Experience: The procedure occurs in an X-ray department, where you’ll lie on an examination table beneath X-ray equipment. A speculum is used to visualise the cervix, and contrast dye is introduced through a small catheter. The experience may involve slightly more intense cramping, particularly when the contrast fills the fallopian tubes.

Both procedures are typically performed without anaesthesia, though some clinics may offer pain relief options. Most women can return to normal activities immediately after either procedure, though mild cramping or light spotting may occur for 24-48 hours.

Accuracy and Clinical Outcomes

Research comparing HyCoSy and HSG demonstrates that both procedures offer comparable accuracy in detecting tubal abnormalities. Clinical studies indicate sensitivity rates of approximately 85-95% for both techniques in identifying blocked fallopian tubes, with specificity rates similarly high.

A systematic review published in fertility journals found no significant difference between HyCoSy and HSG in terms of diagnostic accuracy for tubal patency assessment. Both procedures effectively identify:

Tubal Blockages: Complete or partial obstruction of one or both fallopian tubes.
Uterine Abnormalities: Structural anomalies affecting the uterine cavity shape or size.
Hydrosalpinx: Fluid accumulation within blocked fallopian tubes.
Adhesions: Scar tissue affecting tubal function or mobility.

The choice between procedures often depends on individual circumstances, patient preferences, and clinical considerations rather than significant differences in diagnostic accuracy.

Timing and Preparation

Both HyCoSy and HSG require careful timing and preparation to ensure optimal results and patient safety:

Optimal Timing: Both procedures should be performed in the first half of your menstrual cycle, typically between days 7-12, to avoid potential early pregnancy and ensure the endometrium is appropriately thin for clear visualisation.

Pre-procedure Preparation:

Contraception: Reliable contraception should be used from the start of your cycle until the procedure to prevent pregnancy.
Infection Screening: Some clinics may require screening for sexually transmitted infections before the procedure.
Pain Management: Taking ibuprofen 1-2 hours before the procedure may help reduce discomfort.
Medical History: Inform your clinician about any allergies, particularly to contrast media or medications.

Your healthcare provider will provide specific preparation instructions tailored to your individual circumstances and the chosen procedure.

Cost Considerations and NHS Availability

The availability and cost of HyCoSy versus HSG can vary significantly depending on whether you choose NHS or private healthcare pathways:

NHS Provision: Both procedures may be available through NHS fertility services, though availability varies by region and local commissioning decisions. HSG tends to be more widely available across NHS trusts, whilst HyCoSy availability may be limited to specialist centres.

Private Healthcare: Private fertility clinics typically offer both options, with costs varying depending on location and clinic facilities. HSG may be slightly less expensive in some settings due to established protocols and wider availability of equipment.

When considering costs, factor in potential follow-up appointments, additional imaging requirements, and the overall fertility assessment pathway rather than just the individual procedure cost.

Making Your Decision

Choosing between HyCoSy and HSG involves considering multiple factors specific to your individual circumstances:

Radiation Sensitivity: If you have concerns about radiation exposure or require multiple assessments, HyCoSy may be preferable.
Previous Procedures: Your experience with ultrasound scans versus X-ray procedures may influence your comfort level.
Clinical Complexity: Your clinician may recommend one procedure over another based on your specific medical history.
Availability and Timing: Local availability of equipment and expertise may influence your options.
Personal Preferences: Your comfort with different types of medical procedures and imaging technologies.

Discussing these factors with your healthcare provider will help determine which procedure aligns best with your individual needs and circumstances. Both procedures provide valuable diagnostic information to guide your fertility treatment journey.

How the London Pregnancy Clinic Can Help

At the London Pregnancy Clinic, we offer comprehensive HyCoSy scanning services performed by experienced sonographers using state-of-the-art ultrasound equipment. Our team understands the emotional and physical aspects of fertility investigations and provides compassionate, professional care throughout your assessment.

Our HyCoSy procedures are conducted in comfortable, private facilities with immediate results discussion and detailed reporting for your healthcare providers. We work closely with fertility specialists and can provide comprehensive imaging assessments as part of your broader fertility investigation pathway.

For women requiring additional screening or genetic counselling as part of their fertility journey, we also offer carrier screening tests and genetic counselling services to provide comprehensive reproductive health assessments.

Final Thoughts

Both HyCoSy and HSG represent valuable diagnostic tools in fertility assessment, each offering distinct advantages depending on your individual circumstances. The choice between these procedures should be based on careful consideration of your medical history, personal preferences, and clinical recommendations from your healthcare team.

Remember that these investigations form just one component of comprehensive fertility assessment, and the results will help guide your treatment options and reproductive health decisions. Whether you choose HyCoSy or HSG, both procedures provide crucial information about fallopian tube function and uterine health.

If you’re considering fallopian tube assessment as part of your fertility journey, our experienced team at the London Pregnancy Clinic is here to provide expert care and support. Contact us today to discuss your options and book a consultation to determine the most appropriate diagnostic pathway for your individual needs.