Follicle questions!

[AnonymousXXIX]

Hi ladies,

I just had an ultrasound - in preparation for applying for NHS funding for ICSI - and they saw 7 follicles in my right ovary. And then couldn't find the left one. (It has been found in the past, so we know it exists.)

I was just wondering... what do I do with this info? The internet tells me it would be better to maybe have more than 7 follicles? But then we couldn't see the left one; who knows, maybe that one had more?

Also, would the time in your cycle affect this? (Apologies if that's a stupid question.) I am due my period the coming weekend so maybe it is not really Prime Follicle Time right now? Or does the number stay constant normally?

As far as we are aware our issues are MFI so I am not concerned anything is wrong (unless someone tells me to be!). They also took blood to check AMH and the doctor suggested that should tell us whether it's all good or not. I am just trying to understand the biology, out of curiosity really.

@AnonymousXXIX they count the follicles in both the ovaries and that’s the AFC, which tends to stay fairly stable across cycles but tends to reduce as we get older. My understanding is that the timing of the cycle isn’t that important when it comes to the AFC. I had ovulated and has a corpus luteum present when I had mine. The more follicles there are, the more likely it is that a person will get a good amount of eggs when they are given stimulation medications in IVF. This is a simplification, it gets a bit more complicated for instance, in PCOS one of the diagnostic criteria is a very high AFC.

The AMH Is a blood test that gives some indication of egg reserve and the AMH and AFC are usually fairly consistent with one another. People with a low AMH usually have a low AFC and vice versa.

It sounds like the clinic couldn’t calculate your AFC, as they could only see half of the picture, if your other ovary has the same number of follicles then then would give you a AFC of 14.

It’s the follicles that get stimulated with IVF, each follicles that gets over a certain size could have an egg in it. But huge quantities of eggs aren’t always a good sign, eggs can be immature and some won’t fertilize (even with ICSI).

I hope that’s been helpful, I’m not an expert and your clinic will be best placed for advise. Just picked things up while having IVF!

That's super helpful, thanks @Gardenlady543!

Would a theoretical 14 follicles be a good count?

@AnonymousXXIX I think 14 would be a good number to have for IVF. The eggs collected don’t equal the number of embryos you get, since there will potentially be a drop in numbers with immature eggs, a lack of fertilization and some don’t make it to 5 day blasts. If you ended up with around 14 eggs then that would be a good result to allow for the drop off.

I ended up at the opposite end of the spectrum, with too high a ACF (34)! which is really unusual, since I don’t have PCOS, that meant I was at a high risk of OHSS and could only have mild stimulation. So it’s a bit of a balance.

You’ll have to see what your clinic say about the ovary not being visualised, hopefully as the follicles grown in IVF it will become visible, because they’ll need to see it to collect the eggs!

I had 22 follicles for both ovaries, egg collection I had 17 eggs and 15 mature. I was on a low dose of stims so it seemed to do the trick for me and I didn't overstimulate even though the docs thought I would due to afc

@AnonymousXXIX this happened to me on my 3rd cycle. My left ovary does like to hide! Apparently it's not uncommon. Your ovaries are smallest when they are least active so during your period before the fsh gets going. This is when the follicles are known as "antra follicles" and this is a baseline scan. They are harder to see at this time too. My baseline scans have mostly been during down reg so no action in the ovaries at all. All 3 times I've had more follicles on my right ovary than left and again it's not uncommon to have 1 ovary that is more active. For rounds 1 and 2 more follicles did actually develop. I started with about 8 in total and ended up with about 12 however half of them turned out to be empty. Round 3 I had fewer follicles and no more developed after the baseline. I ended up only getting 2 eggs that round but that is the round that worked! Try not to worry too much (easier said than done I know) they use the afc and AMH to inform the dosage but everybody responds slightly differently. Best of luck x

Thanks @SpyroC, that's really interesting!

I googled a bit and it seems the average for my age would be 15 follicles, so I really hope that left ovary has some more hiding there!

My left had a good few more than my right. I don't remember the exact number but it wasn't extraordinary. As the cycle progressed, I was given extra injections to boost my numbers (which worried me a lot!). Doctor said 10-15 was ideal and I was having the extra injection with that aim. At collection, they seemed surprised to find 27. I had OHSS and a freeze all. 22 fertilized. So from my very limited experience, I would say don't worry about your 7 on one side.