Elsevier

Fertility and Sterility

Volume 94, Issue 6, November 2010, Pages 2182-2185
Fertility and Sterility

Ovary
Antral follicle count: absence of significant midlife decline

https://doi.org/10.1016/j.fertnstert.2009.12.045Get rights and content
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Objective

To examine the conventional wisdom that declines in antral follicle count accelerate after approximately 37 years of age, which has influenced clinical decision making. We critically examine evidence for this sudden acceleration.

Design

Cross-sectional study.

Setting

Academic setting.

Patient(s)

Two hundred fifty-two white women aged 25 to 45 years with regular cycles, a community-based study.

Intervention(s)

Antral follicle counts were measured by transvaginal ultrasound in early follicular phase.

Main Outcome Measure(s)

Determination of the rate of antral follicle count decline with age.

Result(s)

The relationship of antral follicle count with age was determined by comparing a linear model with four nonlinear models (biphasic, quadratic, spline, and power). The linear model estimates the follicle decline as 0.97 follicles per year. The biphasic model had estimates of 0.76 follicles per year before 39.6 years of age and 1.92 follicles per year thereafter. At age 35 years the linear, quadratic, broken line, spline, and power models gave estimated declines (respectively) of 0.97, 0.94, 0.76, 0.17, and 0.90 follicles per year. At age 43 years the values were 0.97, 1.51, 1.92, 1.78, and 1.64 follicles per year. The quality of model fit was comparable for all models.

Conclusion(s)

Antral follicle count decline with age in a white population is best described as a gradual acceleration in decline with age. Therefore antral follicle count alone should not be used to determine aggressive treatment because of fear of rapid loss of follicles.

Key Words

AFC
ovarian aging
age-related infertility

Cited by (0)

M.P.R. has nothing to disclose. B.S. has nothing to disclose. S.M.S.-H. has nothing to disclose. R.A.R.P. has nothing to disclose. C.E.M. has nothing to disclose. M.I.C. has nothing to disclose.

Supported by the National Institutes of Health (NIH)/National Institute of Child Health and Human Development and NIH/National Institute on Aging grant R01 HD044876 and by NIH/National Center for Research Resources UCSF-CTSI grant UL1 RR024131.

The contents of this project are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.