egg count

Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time. 

A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.

AMH and its role in fertility

So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

What is a low AMH result?

As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.

In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.

What does a low AMH mean?

Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is. 

So what does this mean in terms of fertility?

First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications. 

If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Reasons AMH would be low

There are a few reasons that could explain a low AMH. Let’s explore them.

Natural decline with aging

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Hormonal birth control

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

You can learn more about birth control and AMH here.

Tobacco use

Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

Less common causes 

There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome.
• Medical treatments like radiation or chemotherapy.
• Having surgery on your ovaries.
• Losing one or both of your ovaries.
• Autoimmune conditions.

Can I still donate my eggs with a low AMH?

If you are looking to donate your eggs, minimum AMH requirements are usually 2.0 or above. With Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What to do if you have a low AMH result

Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom. 

Let’s go through a few things you can do as you move forward with this new information. 

Lean on your village

The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them. 

Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely. 

Consult a fertility specialist

Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you. 

So does this mean I have to freeze my eggs ASAP?

This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

How Cofertility can help

Cofertility is here to help you every step of the way on that journey. Our Split program offers women a chance to freeze their eggs for free when donating half the eggs retrieved to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time! 

Your journey is uniquely yours and our team is here to help you through it in whatever way you need.

If you're considering or embarking on the path of egg freezing, you may have come across the term "Antral Follicle Count" (AFC) during your research. AFC is a crucial tool in assessing ovarian reserve and predicting the success of fertility treatments, including egg freezing. In this article, we delve into the world of AFC, exploring its significance, measurement techniques, and its role in optimizing your egg freezing journey.

In this comprehensive guide, we will walk you through the intricacies of AFC. We'll discuss what an antral follicle is, how AFC is measured, and what a normal AFC looks like based on age. Additionally, we'll explore the relationship between AFC and the egg freezing process, shedding light on how this information can guide and optimize your fertility journey.

What is an antral follicle?

Antral follicles are small fluid-filled sacs found within the ovaries that contain immature eggs. These follicles serve as the building blocks of our fertility. Each month, a group of antral follicles starts developing in response to hormonal signals. Among this group, one follicle becomes dominant and eventually releases a mature egg during ovulation.

How do you measure AFC?

There’s only one way to measure the antral follicle count: through a transvaginal ultrasound, which allows for a close examination of the ovaries. During this procedure, a specialized ultrasound probe is inserted into the vagina to visualize the ovaries and count the number of antral follicles present in both ovaries (the definition of antral follicles varies across fertility clinics. Some clinics count follicles that measure 2–10 mm in diameter, while others focus on follicles ranging from 3–8 mm). 

The AFC measurement is typically taken during the early follicular phase of the menstrual cycle when the antral follicles are at their most visible and measurable state. But it can be done anytime of the cycle.

What can an antral follicle count test tell you?

The antral follicle test holds a wealth of valuable information that can shed light on your reproductive health. So, what exactly can an antral follicle test tell you?

Ovarian reserve assessment 

The number of antral follicles detected during the test directly correlates with your ovarian reserve. This information can help your fertility doctor understand the quantity of follicles remaining in your ovaries in relation to your age. As we age, the number of antral follicles typically decreases, reflecting a decline in ovarian reserve. Understanding this relationship can help in making decisions about family planning and fertility preservation options. Learn more about ovarian reserve here.

How your body would respond to egg freezing

Antral follicles are a key determinant of how your ovaries will respond to ovarian stimulation during fertility treatments such as egg freezing. In fact, AFC correlates directly with the number of eggs retrieved at egg collection. By assessing your AFC, your healthcare team can tailor the stimulation protocol to optimize your chances of success.

Best timing for egg freezing 

The antral follicle count can also assist in determining the ideal timing for initiating fertility treatments. By assessing the AFC, your fertility doctor can guide you on the optimal time to start treatments, maximizing your chances of a successful outcome.

Premature ovarian failure (POF)

POF, also known as premature menopause, refers to the loss of ovarian function before the age of 40. Antral follicle testing can help in the diagnosis of POF by revealing a significantly reduced antral follicle count. A diminished AFC can indicate a decline in ovarian reserve, which is a characteristic feature of POF. This information is crucial in understanding the reproductive potential and considering appropriate fertility treatment options for individuals with POF.

Polycystic ovary syndrome (PCOS) 

PCOS is a common hormonal disorder that affects women of reproductive age. It is characterized by hormonal imbalances, irregular menstrual cycles, and the presence of multiple small follicles on the ovaries. Antral follicle testing plays a vital role in assessing PCOS by revealing an increased number of small antral follicles during the scan. This high AFC, along with other diagnostic criteria, helps in confirming the presence of PCOS and guiding appropriate management strategies.

The antral follicle test is a powerful tool in assessing your fertility health, but it is just one piece of the puzzle. It should be considered alongside other diagnostic measures and discussions with your fertility doctor to form a comprehensive understanding of your fertility health.

What is a normal AFC by age?

The normal range of antral follicle count can vary depending on your age. In general, younger women tend to have a higher number of antral follicles, indicating a larger ovarian reserve. As a woman ages, the number of antral follicles naturally declines, reflecting the diminishing ovarian reserve.

While the specific numbers can vary, a typical AFC for a woman in her 20s and early 30s may range between 10-20 follicles, in her late 30s around 8-15 follicles, and by her 40s, it could further decline to under 10 follicles. It's important to remember that these numbers are approximate and can vary based on individual factors such as genetics and overall reproductive health.

One study of infertile women looked at exactly how antral follicle count declines with age, finding the median AFC to be:

• 14 at age 25
• 12 at age 30
• 10 at age 35
• 8 at age 40
• 6 at age 45

AFC and egg freezing

When it comes to assessing ovarian reserve and predicting the number of eggs that can be retrieved during egg freezing, the antral follicle count (AFC) is a very helpful biomarker. It may even be the most important of ovarian reserve measures. A meta-analysis of 11 studies found that the AFC scan was as accurate as using multiple markers to predict ovarian response to stimulation. AFC outshined its counterparts like anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) as the predictor of ovarian response to egg freezing stimulation. 

So, when it comes to determining the potential success of your egg freezing journey, keep an eye on AFC. It can guide you through the uncertainties and help your healthcare team tailor the stimulation protocol to maximize your chances of a fruitful outcome. 

What does low AFC mean?

A low AFC can indicate a lower ovarian reserve and may have implications for fertility. When the AFC is low, it suggests that there are fewer follicles available in the ovaries, which can impact the number of eggs that can be retrieved during fertility treatments such as egg freezing.

But having a low AFC does not necessarily mean that pregnancy is impossible, but it may suggest that the response to ovarian stimulation during fertility treatments could be lower than average. With fewer follicles available, there may be a reduced number of mature eggs that can be retrieved for fertilization. This can affect the overall success rates of fertility treatments, as the quantity and quality of eggs play a crucial role in achieving a successful pregnancy now or down the line.

Remember that AFC is just one piece of the fertility puzzle, and other factors such as age, hormone levels, and overall reproductive health matter. 

What does high AFC mean?

A high AFC typically indicates a greater ovarian reserve and can be a positive indicator of fertility health. When the AFC is high, it suggests that there are a larger number of antral follicles present in the ovaries, which can potentially result in a higher number of eggs available for retrieval during egg freezing.

Having a high AFC is generally associated with a better response to ovarian stimulation during fertility treatments. With more follicles available, there is a greater likelihood of obtaining a larger number of mature eggs for fertilization. This can potentially increase the chances of success in achieving a pregnancy now or down the line.

A high AFC alone does not guarantee pregnancy or fertility success. Other factors such as the quality of the eggs, age, overall health, underlying reproductive conditions – as well as the health of the sperm – can also influence fertility outcomes. 

AFC is just one piece of the puzzle

The antral follicle count is a valuable tool in the realm of fertility assessment. By providing information about your ovarian reserve, it assists in predicting the response to ovarian stimulation and guides decisions regarding fertility preservation options like egg freezing. 

The AFC measurement, combined with other diagnostic tests and a thorough evaluation of an overall reproductive health, helps paint a comprehensive picture of your fertility health. Armed with this knowledge, you can make informed choices about your reproductive journey and take proactive steps towards preserving your fertility and achieving your family planning goals.

You are not a number

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like.

Cofertility is here to help you every step of the way on that journey.

Our Split program allows qualified people between 21 to 34 years old (with an AMH of 2+) to have the chance to freeze their eggs for free when donating half of the eggs retrieved to a family that can’t otherwise conceive.

Or, if you’re over 34, you can still participate in the Keep program up to age 40. In the Keep program, you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community, the Nest. This valuable resource lets you engage with other people freezing their eggs at the same time!

Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.

Sources:

• Antral Follicle. Science Direct. URL
• Verhagen TE, Hendriks DJ, Bancsi LF, et al. The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis. Hum Reprod Update 2008;14:95–100. URL
• CAROLE GILLING-SMITH, STEPHEN FRANKS, CHAPTER 28 - Ovarian Function in Assisted Reproduction, The Ovary (Second Edition), Academic Press, 2004, Pages 473-488, ISBN 9780124445628, https://doi.org/10.1016/B978-012444562-8/50029-X. URL‍
• Almog B, Shehata F, Shalom-Paz E, Tan SL, Tulandi T. Age-related normogram for antral follicle count: McGill reference guide. Fertil Steril. 2011;95(2):663-666. doi:10.1016/j.fertnstert.2010.08.047 URL

Anti-Müllerian hormone (AMH) has gained significant attention in the field of reproductive medicine as a valuable marker of ovarian reserve. It provides insight into egg quantity and can be useful in assessing fertility health and predicting the chances of egg freezing success. 

However, there are certain medications that can potentially influence AMH levels, raising questions about the accuracy and interpretation of AMH testing while on them. In this article, we will explore the relationship between medications and AMH levels, shedding light on the impact of specific drugs and discussing their implications for women's reproductive health.

What is AMH?

AMH is a hormone produced by the cells within ovarian follicles. Its primary role is to promote the growth and development of follicles. AMH levels are generally stable during the menstrual cycle, making it a reliable marker for assessing ovarian reserve. It is measured through a simple blood test and has become an important tool in fertility evaluations and treatment planning.

What causes AMH to change?

AMH levels naturally decline as we age. The highest levels of AMH are typically found in women during their early reproductive years, and the levels gradually decrease as we approach menopause… making age the most common reason for AMH to change.

But there are other reasons AMH may change over time. The most common reason is simply age. Since AMH is considered a reliable marker of ovarian reserve, which refers to the quantity of eggs remaining in the ovaries, this hormone naturally decreases as we get older.

Certain medical conditions, such as ovarian tumors, can also affect AMH levels. Additionally, treatments like chemotherapy or radiation therapy that target the ovaries can significantly reduce AMH levels.

While the direct impact of lifestyle factors on AMH levels is not yet fully understood, some studies suggest that factors such as smoking, obesity, and extreme exercise may be associated with lower AMH levels. However, more research is needed to establish definitive conclusions.

Lastly, certain medications can impact AMH levels. For example, oral contraceptives and drugs like clomiphene citrate used in fertility treatments can temporarily decrease AMH levels. On the other hand, supplements like DHEA (dehydroepiandrosterone) and vitamin D have been associated with increased AMH levels. We’ll go more into detail about these below.

Remember that individual variations exist, and AMH levels should be interpreted in conjunction with other fertility assessments to gain a comprehensive understanding of your reproductive health. If you have concerns about your AMH levels or fertility, it's best to consult with a fertility doctor for personalized guidance and recommendations.

What medications can affect AMH levels?

Several medications have been found to influence AMH levels, potentially complicating its interpretation as a marker of ovarian reserve. Here are some examples:

Oral birth control 

Oral contraceptives are commonly used for birth control and to regulate menstrual cycles. Studies have suggested that oral contraceptive use may lead to decreased AMH levels in the short term.

One study compared the AMH levels of 228 hormonal contraception users and 504 non-users. They found that users of birth control had 29.8% lower AMH concentrations. Because of this, the authors concluded that AMH may not be an accurate predictor for women using hormonal contraception.

You may want to consider the timing of the AMH test when using hormonal contraceptives. Estrogen can suppress the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for the development and maturation of follicles. 

As AMH levels are influenced by FSH and LH, you could wait for a few weeks after discontinuing birth control before measuring AMH levels for a more accurate assessment of ovarian reserve. Or, you could take the test knowing the results may be lower due to birth control. It’s best to discuss this with your doctor.  

Metformin

Metformin is a medication commonly used in the treatment of polycystic ovary syndrome (PCOS), a complex endocrine disorder associated with metabolic and reproductive disturbances, and for managing insulin resistance. Research has shown that metformin use may be associated with decreased AMH levels.

Clomiphene Citrate

Clomiphene citrate (brand name Clomid©), is a medication used to stimulate ovulation in women who are trying to conceive. Similar to metformin, clomiphene citrate has been associated with decreased AMH levels. When undergoing fertility treatments involving clomiphene citrate, you’ll want to take this potential impact into account when interpreting AMH results.

What supplements can affect AMH levels?

Dehydroepiandrosterone (DHEA)

DHEA is a natural hormone that can be converted into other hormones in the body, including testosterone and estrogen. Some studies have suggested that supplementation with DHEA may lead to increased AMH levels. These findings suggest that certain nutritional interventions may have a positive effect on ovarian reserve.

Vitamin D

Vitamin D is essential for overall health and has been linked to various biological processes in the body, including reproductive health. Some research indicates that vitamin D supplementation may lead to increased AMH levels. However, more studies are needed to fully understand the relationship between vitamin D and AMH levels.

Is there anything I can take to increase AMH levels?

While there are medications and supplements that have been associated with changes in AMH levels, the impact of these medications is typically temporary or specific to certain conditions. 

Currently, there is no definitive medication or treatment specifically designed to increase AMH levels. However, there are lifestyle factors that may positively influence overall reproductive health, such as maintaining a healthy weight, adopting a balanced diet, managing stress levels, and avoiding smoking and excessive alcohol consumption. These lifestyle choices can contribute to optimal ovarian function and potentially support healthy AMH levels.

Summing it up

AMH testing has revolutionized our ability to assess ovarian reserve and guide fertility treatment decisions. However, it's crucial to consider the potential influence of certain medications on AMH levels. Understanding how specific drugs and supplements may affect AMH results can help you interpret the findings accurately and make informed decisions about fertility treatments. 

Remember that these effects are usually temporary or specific to certain conditions. It's always best to consult with your fertility doctor who can provide personalized guidance based on your specific situation. 

Better yet, focusing on maintaining a healthy lifestyle, managing stress levels, and adopting a balanced diet can contribute to overall reproductive health and support optimal ovarian function. By staying informed and working closely with your healthcare team, you can navigate the complexities of AMH testing and make informed decisions about your fertility journey.

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Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

In the world of reproductive health and fertility, there is a growing interest in understanding the quantity of eggs a woman has, also known as ovarian reserve. The concept of measuring ovarian reserve has gained popularity as more people seek to assess their fertility potential and make informed decisions about family planning. 

But can you truly measure how many eggs you have? Let's delve into the world of ovarian reserve testing and explore the possibilities and limitations.

How many eggs do females have?

Females are born with approximately one to two million oocytes, and it only goes down from here since no new eggs are made. But here's where it gets interesting.

Once we reach puberty, a process triggered by a complex interplay of hormones, only about 300,000 of these oocytes will remain. These precious few will have the opportunity to mature and potentially be released as eggs during our reproductive years. Our bodies typically release just one egg per menstrual cycle, and this process occurs approximately 400 times throughout our lifetime.

These remaining oocytes are not merely passive bystanders. Each one resides within a protective structure called a follicle, where it lies dormant and suspended in the middle of a cell division. Remarkably, the lifespan of an egg is one of the longest among the body's cells. However, this extended duration can also increase the chances of damage and genetic abnormalities as we age.

At menopause, which is defined as one year after your last menstrual period, the pool of remaining oocytes steadily declines until none remain. This natural process signifies the end of our reproductive years.

Understanding the intricacies of egg development and the limited supply available underscores the importance of considering fertility and family planning at an earlier age. Each egg is a precious resource, and its quality and viability can impact the chances of achieving a successful pregnancy. Exploring fertility preservation options, such as egg freezing, can provide women with greater control over their reproductive future.

While the numbers presented here provide a general understanding, it's crucial to remember that everyone’s ovarian reserve is unique. Factors like genetics, lifestyle, and overall health can influence the rate of egg loss and fertility potential. 

Egg count and age

As stated above, females are born with one to two million eggs. By puberty, only about 300,000 of these oocytes will remain. After starting the menstrual cycle, we lose about 1,000 immature eggs every month… meaning by age 37 there are around 25,000 eggs remaining. And by menopause, no more eggs remain.

Here is a rough chart of what this could look like for an individual. Keep in mind that everyone starts with a different number of eggs, and everyone’s rate of decline varies. This chart is just to give you an idea of what this egg count could look like: 

Measuring egg reserve (aka ovarian reserve)

Ovarian reserve refers to the number of eggs remaining in a woman's ovaries at a given time. It is one indicator of a woman's reproductive health, and can help guide fertility treatment decisions. The idea of quantifying ovarian reserve has gained significance as women strive to gain insights into their fertility and make proactive choices about their reproductive journey. And at the same time, at-home tests make it easier to measure your ovarian reserve.

Keep in mind that the number of eggs you have does not necessarily equate to your ability to conceive. Other factors, such as egg quality, the presence of any reproductive disorders, and the overall health of the reproductive system, play significant roles in fertility. Not to mention the health of the sperm! Some people have lower ovarian reserve but still achieve successful pregnancies, while others with a seemingly healthy ovarian reserve may face challenges in conceiving.

How to measure ovarian reserve

One of the most commonly used methods to measure ovarian reserve is through a blood test that evaluates specific hormone levels. These hormones include anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol. AMH, in particular, has emerged as a reliable marker of ovarian reserve, as it reflects the number of small follicles in the ovaries that contain immature eggs. Low levels of AMH may indicate a diminished ovarian reserve, while higher levels may suggest a larger pool of eggs.

While ovarian reserve testing provides valuable insights, it is not a crystal ball that can predict fertility outcomes with absolute certainty. Ovarian reserve is just one piece of the fertility puzzle, and other factors such as egg quality, uterine health, and sperm quality also play crucial roles in the conception process. Additionally, fertility is influenced by various external factors, including age, lifestyle, and underlying health conditions.

Fertility testing can provide a snapshot of ovarian reserve at a specific moment in time. Ovarian reserve naturally declines with age, and the number of eggs available for fertilization decreases over time. Therefore, it's crucial to interpret the results in the context of your age and overall health.

Egg reserve testing methods

Another consideration when evaluating ovarian reserve is the variation in testing methods and reference ranges used by different laboratories. Each laboratory may have its own set of standards and measurements, which can lead to variations in results. You may want to consult with a fertility doctor who is knowledgeable in reproductive medicine to interpret the test results accurately and provide personalized guidance (if you work with Cofertility, we can help you set this up).

So, can you measure exactly how many eggs you have?

While ovarian reserve testing can provide valuable information, determining the exact number of eggs a woman has remaining in the ovaries is not possible. 

Why? First of all, the number of eggs in the ovaries is not static but rather dynamic and constantly changing. We are born with a finite number of eggs, and this number gradually declines over time through a process called follicular atresia. This natural process of egg loss occurs throughout our reproductive years, and the rate of decline varies from person to person.

Second, the accuracy of measuring the exact number of eggs is hindered by the limitations of current medical technology. While imaging techniques like ultrasound can visualize the presence of ovarian follicles, they cannot precisely determine the number of eggs within each follicle. Additionally, even if the number of follicles can be counted, it does not equate to the exact number of eggs, as not all follicles contain a viable egg.

Ovarian reserve is just one piece of the puzzle

While ovarian reserve testing can provide valuable information, it is just one tool in the broader landscape of fertility assessment. A fertility doctor can consider your medical history, conduct a physical examination, measure your antral follicle count, and may recommend additional tests or imaging studies to provide a comprehensive assessment of your reproductive potential.

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Cofertility is a human-first fertility ecosystem rewriting the egg freezing experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

You might have heard at some point that freezing your eggs can help you preserve your fertility options for your long term future. But just how many eggs should you freeze? Is there an optimal number for egg freezing?

Let’s take a look at how many eggs you can expect to get during the retrieval process and how many eggs you should be freezing for fertility preservation. 

How many eggs do I have?

Before we talk about the number of eggs you should freeze during oocyte cryopreservation — more commonly known as freezing your eggs — we should probably talk about how many eggs are in your ovaries right now. 

Your fertility doctor may have mentioned the term ovarian reserve a few times. When they do that, they’re talking about the number of eggs in your body. But how many eggs are in that reserve?

There is no exact answer here. On average, women are born with anywhere from one to two million eggs. Some women are born with more. Some women are born with less. 

It may sound like a lot either way, but most of the eggs we’re born with don’t stick around. By the time most of us hit adolescence,we have about 300,000 eggs left. From there, the number of eggs in the body naturally decreases by about 1,000 every year, and the decline becomes more rapid after age 35.  

That’s where egg freezing comes into play. The doctors of the Association of Reproductive Medicine (ASRM) states that planned oocyte preservation is “ethically permissible” because it provides women with more autonomy over their reproductive choices. 

Doctors can get a sense of how large your ovarian reserve is before egg freezing by testing the level of the anti-Müllerian hormone (AMH) in your body. This test looks at both your ovarian reserve and how well your body may or may not respond to medications that will stimulate the ovaries. What it can’t determine, however, is the quality of those eggs. And ultimately, you need both quantity and quality.

How many eggs do I need to freeze?

OK, so you may have a lot of eggs in your ovarian reserve — or maybe not. But how many do you actually need to freeze?

This answer varies from person to person and depends on a few individual factors:

• How old are you right now?
• Do you plan to freeze all of your eggs or do you hope to also donate some to help intended parents grow their family? 
• If you think you may want to have children one day, how many do you have in mind?

This list presents a lot to think about, so let’s dive a little deeper to help you make informed decisions about the number of eggs you freeze. 

The right number of eggs to freeze for your age

Different folks have different reasons for freezing their eggs. Some may be thinking about prolonging their fertility into the future. Others may be freezing some eggs but also hoping to donate some eggs to help others grow a family — something that’s done via our Split program, where you freeze for free when donating half of the eggs to a family that can’t otherwise conceive. 

Either way, studies have found that the optimal number of eggs to freeze really comes down to your age. That’s because the number of eggs in the body isn’t the only thing to decrease as you get older — egg quality decreases too, and egg quality is the number one factor in determining whether an egg can eventually result in a live birth. 

Here are the number of eggs you’ll want to freeze based on your age in order to obtain an optimal live birth rate:

How many eggs are retrieved?

For  egg donors aged 25-29, the average number of eggs retrieved is 18, and that number drops to 16 for people age 30-35 — although it varies from person to person.

Your reproductive endocrinologist will be able to tell you the day of your retrieval how many eggs were retrieved. This number will include both mature and immature eggs, so it’s not necessarily the total number of eggs that can be frozen. 

Immature Eggs

• May be partially or completely damaged or have its quality compromised in some way
• Lower chance of fertilization

Mature Eggs

• Have good egg quality
• Are more likely to be fertilized
• Can be frozen

After your retrieval, all of your eggs will be sent to an incubator to check maturity. The lab technicians will look for eggs to achieve meiosis, a kind of cell division that occurs in egg cells. 

The eggs that achieve meiosis will be frozen, and you will be notified of the total number. 

Should I do multiple egg retrievals?

What happens if you don’t get as many eggs as you had hoped during your egg retrieval cycle? 

If you’ve undergone one round of egg freezing and the number of eggs your reproductive endocrinologist retrieved from your ovaries wasn’t as high as you’d hoped, you may want to talk to them about trying again. 

There is technically no limit to the number of egg freezing rounds a person can undergo, but it’s not recommended that egg donors undergo more than six cycles. If you’re hoping to split your eggs with intended parents (donating half of the eggs retrieved) as part of our Split Program, you may find that additional retrievals help you provide the optimal amount of eggs for a live birth for you and for the intentend parents too. 

Of course, you should talk to your doctor about any risks or benefits that come with additional rounds. 

The right number of eggs to freeze to have multiple children

If you’re planning to have a big family one day, you may want to look at the number of eggs it’s recommended you freeze to achieve one live birth and talk to your doctor about freezing more eggs. 

For example, the studies show that a woman under age 35 will need to freeze about nine eggs to achieve a 70% chance of a live birth. If you’re under age 35 now and thinking you might want to use frozen eggs to conceive twice in your future, you will want to freeze closer to 18 eggs to achieve that 70% chance each time. 

That number will increase with each number of children you foresee — provided your expectation is that each child will be conceived with the use of the eggs you are currently freezing. 

Bottom line

There is no “magic number” when it comes to freezing your eggs. Your age, your future plans, and more all come into play. 

We’re here to answer any questions you might have, and the Cofertility community is also here to lend support as you consider all the important factors to make the choice that is right for you.

Our goal at Cofertility is to match intended parents with Split members who can help them achieve their goal of parenthood.  Because of that, we want to make sure we’re upfront about what might disqualify someone from our Split program. 

Through this program, you can freeze your eggs for free if you donate half to a family who can’t otherwise conceive. But, importantly, several factors may limit your eligibility.  Some of these are official disqualifiers based on regulations by the Food and Drug Administration (FDA). Others are discretionary disqualifications based on recommendations by governing bodies like the American Society for Reproductive Medicine (ASRM). 

While it’s not possible to create an exhaustive list of every reason someone may not qualify for our Split program, this guide outlines some of the most common reasons for disqualification.

Age

To apply to be a part of the Split Program, you must be between the ages of 21-33. This is because you’ll need to complete your retrieval before you turn 35, so because the process can take some time, we don’t accept applicants who are 34 or older. 

The reason for this age limitation is because data shows that, on average, those over 35 tend not to respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. Various factors may affect your cycle timing (application paperwork, time to match with a family, and more) and you will need to cycle before you turn 35. We’d hate for someone to apply, get accepted, and then when the time comes for the cycle itself, potentially age out.

If you are 34-39, you are still eligible to participate in our Keep program. With this program, you can freeze your eggs and keep 100% of them for yourself. 

If you are under 21 and you’d like to participate, please reach out and we’ll get back in touch after you turn 21. 

Health-related factors 

As a preliminary step in the process, we’ll review several health-related factors. 

For starters, you’ll need to have two ovaries and you cannot have taken a Depo Provera shot, which can interfere with hormonal medications, within the past 6 months. 

Due to these hormonal medications you’ll need to take during egg freezing, you also cannot be currently pregnant or breastfeeding. However, if you plan to stop breastfeeding within the next six months, you can still go through with your Split application. You’d just need to hold off on your actual freezing cycle until then, and this situation would be communicated to potential match families. 

Additionally, you’ll need to have a BMI of 18-29. Those outside of this range are at increased risk of complications, negative outcomes, and negative side effects from hormonal medications or an egg retrieval. 

You will not qualify if you’ve had a sexually transmitted disease within the past 12 months (but can apply after 12 months of treatment). You also will be disqualified if you’ve been refused as a blood donor due to other infectious disease or medical conditions. Same goes if you’ve ever had a blood transfusion. 

Medical and family history

We will also review your and your family’s medical history. Unfortunately, this means that if you are adopted and cannot confirm your biological family’s medical history, you will not qualify. 

Though not an exhaustive list of every condition that may disqualify a member, when reviewing your personal and family medical history, we look for personal and/or family history of:

• Cancer
• Heart/blood disease
• Neurological diseases
• Mental health disorders
• Thyroid disorders
• Genetic disease
• Fertility issues
• Reproductive disease
• Autoimmune disease
• Respiratory disease
• Metabolic disease
• Gastrointestinal disease
• Kidney disease
• Birth defects

We review your personal and family medical history as a whole with our medical advisors. When reviewing, we consider the severity of the disease/conditions, number of relatives with the disease/condition, age of diagnosis, as well as that relative’s relation to you.

Psychological screening

There are also some psychological questions you’ll have to answer. We don’t expect you to be perfect. But note that certain psychological factors may be more likely to disqualify you than others. 

For example, a history of physical, sexual or substance abuse or having family members with psychiatric disorders that could be passed down may make it more difficult to be approved than, for example, having had some mild depression or anxiety. Per ASRM guidance, we will exclude those with a personal or first-degree (parents, siblings, offspring) family history of: 

• Bipolar disorder
• Schizophrenia
• Schizoaffective disorder
• Severe depression
• History of alcoholism or drug abuse

Genetic screening

As part of the process, you’ll also be required to do genetic testing via blood test or saliva sample. This helps ensure that embryos resulting from your eggs will lead to a viable pregnancy and that a child won't be born with severe disease. 

But even for serious diseases, not all disease-related genes are deal breakers. For example, if we find that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may or may not disqualify you; it can depend on the clinic and genes of the intended parents. 

In line with ASRM guidance, in most conditions where carrying one copy of a particular gene won't impact the child themselves, you can still qualify for the Split program. 

Physical screening

In addition to genetic screening, you will have to undergo a physical screening to ensure you are physically healthy and producing a good number of eggs.  

Some disqualifications here are set in stone by the Food and Drug Administration (FDA). If evidence of any of these conditions arises, you will be considered ineligible for the program. These are considered to be non-negotiable.

• HIV
• Hepatitis B
• Hepatitis C
• Human transmissible spongiform encephalopathy
• Treponema pallidum

The following could also be deal breakers: 

• Issues with your ovaries, such as having only one ovary
• Hormone levels outside of recommended limits with concerns about your ability to produce sufficient eggs
• Any issues that would make the egg freezing and donation process risky for your health
• Evidence that you are at high risk of getting a sexually transmitted disease or could already have one. Doctors will look for discharge or ulcerative lesions for this purpose
• Indicators of possible drug use (needle tracks, for example) or exposure to needles in non-sterile conditions—including recent piercings or tattoos within the past 12 months

Anti-Mullerian hormone (ovarian reserve) levels

As you likely know, women have a set egg quantity present at birth. Your eggs mature in ovarian follicles, and each of these follicles produces the anti-Mullerian hormone (AMH). Over time, this hormone level drops; eventually, it drops so low that women naturally develop what's known as a diminished ovarian reserve (DOR).

Your AMH level can help predict how well medication may work to stimulate your ovaries to produce eggs. It also tells doctors what dosage of drugs may be needed to do so. The higher the AMH level, the more eggs generally produced. 

At Cofertility, if your AMH < 2, you are ineligible for our Split program. We only accept Split Members with these higher AMH levels as it helps mitigate the possibility of a second cycle to obtain enough eggs that could result in a live birth down the line (for yourself and for intended parents). Nevertheless, it’s important to note that, even with a high AMH level, there is always a chance that you need to do another cycle to improve the odds of a live birth. In the Split Program, you will receive AMH-reading bloodwork prior to being activated on our platform. 

If it turns out that your AMH levels are below the required minimum threshold, you would unfortunately be ineligible to move forward with egg donation. However, we can still help you freeze your eggs for your own future use through our Keep program.

State-specific qualifications

Some states do maintain their own requirements for women who are donating eggs. These requirements will extend to those in our Split program and would be determined by the location of the clinic at which you would be conducting the retrieval. 

Any state-specific egg donation qualifications will be evaluated at the time of your physical examination. 

Additional disqualifying factors

Lastly, there are a few additional factors that, unfortunately, would disqualify you from our Split program. These include if you:

• Have served jail time for more than two days within the previous 12 months
• Have undergone body piercing and/or tattooing within the past twelve months in which sterile procedures may not have been used
• Have the highest education level of GED
• Have Indigenous American ancestry and are associated with a tribe — this is due to the Indian Welfare Act 
• Currently use any nicotine products regularly, since the ASRM has confirmed an association between smoking and decreased fertility — if you engage in vaping, you will need to quit for 2-3 months before re-applying for Split, but if you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date

If one or more of the above applies to you and you’d still like to participate in our Split program, reach out to us. We’d be happy to chat with you about your fertility options, including your ability to re-apply in the future. 

The net net

We know this sounds like a lot, but these disqualifiers are in place to respect the health and wellbeing of our Split members and intended parents. If you have any questions about Split—including the factors outlined here—don’t hesitate to connect with us. 

You have tons to offer, and whether you qualify for the Split program is in no way reflective of your value. The most important thing is that you feel one hundred percent comfortable in any decision you make. This is a big one, and we’re with you every step of the way.

Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.

First off, what is AMH?

AMH is a hormone that is produced by the granulosa cells in the ovarian follicles. It plays a role in the growth and maturation of ovarian follicles in females. AMH levels are relatively stable throughout the menstrual cycle and can be measured in the blood.

AMH is commonly used as a marker of ovarian reserve, which is a rough number of eggs that a female has remaining in her ovaries. Since females are born with a fixed number of eggs, this number naturally declines over time. 

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

If you are looking to donate your eggs, however, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What AMH level is considered high?

In healthy females of reproductive age, higher levels of AMH mean that the ovaries have a larger supply of eggs. This means one would be expected to have better than average outcomes for egg freezing. 

Remember, there is no universal standard for AMH, so it can vary depending on the lab where the test is run. Your test results will include if your range is “normal”, “low”, or “high” and the cut-off can differ. For example, Atlanta Fertility considers over 4.5 ng/mL high. Advanced Fertility considers anything over 4.0 ng/ml high. While RMA would consider an AMH over  3.0 ng/ml as “very high”.

With high levels of AMH, you may be at higher risk for ovarian hyperstimulation syndrome (OHSS). This means your doctor may choose a specific protocol and/or do extra monitoring to decrease the risk of complications during egg freezing.

What AMH level is considered too high?

Again, this question depends on the lab. Your test results will come with a reference range, and will indicate if your number is high for your age. If your doctor considers your levels abnormally high and has concerns, they will discuss the results with you. 

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Does high AMH always mean PCOS?

While an increase in AMH levels has been reported to be associated with PCOS, high AMH alone is not enough to diagnose PCOS. 

Not all patients with PCOS have high AMH levels, and not all patients with high AMH levels have PCOS. Diagnosis of PCOS requires a combination of symptoms, hormone levels, and imaging studies, such as ultrasound.

Does high AMH mean good egg quality?

Not necessarily. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

Am I ovulating if my AMH is high?

AMH levels do not indicate if you’re ovulating or not. Ovulation is the release of a mature egg from the ovary and can be confirmed by monitoring the menstrual cycle and/or performing ultrasound studies.

Will I get a lot of eggs if I have a high AMH?

The success of egg freezing outcomes largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the doctor performing the procedure.

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Freeze your eggs with Cofertility

One option to make egg freezing better is working with Cofertility. Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. 

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other. It also enables access to exclusive guidance, free expertise, and community events. 

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.

Summing it up

A high AMH level is generally a good sign for your ability to successfully freeze your eggs. But for some, it can also be one indicator of PCOS. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality (egg quality is more dependent on age). 

AMH levels are commonly used as a marker of ovarian reserve and can be helpful, in conjunction with other measures, in predicting the number of eggs that can be retrieved during an egg freezing cycle. However, it is important to keep in mind that egg quality is determined by several factors and cannot be measured directly by AMH levels. If you have concerns about your fertility or AMH levels, it is important to speak with a fertility doctor for personalized advice and treatment options.

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Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• Do’s and Don’ts During Egg Freezing: Alcohol, Baths, Exercise, and More

Embarking on the path of family planning is an exciting journey filled with hope and, often, uncertainty. One area that typically gives rise to a multitude of questions revolves around oocyte cryopreservation, commonly known as egg freezing. While this medical breakthrough has provided countless women with greater reproductive autonomy, it's still not a definitive guarantee of biological motherhood.

In this guide, we’ll try and answer one of the most common questions around egg freezing: the chances of live birth. 

From frozen eggs to baby

At every stage of the in vitro fertilization (IVF) process (which is technically what egg freezing is, plus embryo fertilization in a lab), there's a certain level of attrition. Some collected eggs may be immature, making them unsuitable for freezing. Others may not withstand the thawing process. When you’re ready to fertilize those eggs into embryos, they will not necessarily all fertilize, and some fertilized embryos may fail to mature into viable embryos suitable for transfer. Even embryos that reach the transfer stage might not be genetically normal. And those that are genetically normal may not result in a viable pregnancy or live birth.

As a result, egg freezing is better viewed as a way to increase your chances of pregnancy down the line, rather than an insurance policy or a surefire plan. It’s a path filled with potential, and definitely gives you greater optionality when you’re ready to  have kids, but — and we are always very transparent about this — there is unfortunately no absolute promise of a live birth at the end of the egg freezing process.

How many eggs should I freeze?

Given these complexities, a pressing question for many women is, “how many eggs should I freeze to increase my chances of having a baby?” The answer is nuanced and largely depends on two variables: the age at which the eggs are frozen, and how many children you want.

Unfortunately, the quality of eggs can't be assessed before fertilization is attempted, adding another layer of uncertainty to this equation. Still, we can provide an approximate guide based on averages, which can inform individualized counseling, treatment planning, and expectation management.

One study out of Harvard Medical School of 520 cycles found the chances of live birth varies based on age and number of eggs frozen (see chart below). This guidance is not precise, but offers an approximate benchmark to guide you through your fertility journey. 

How many eggs will I get?

Another common inquiry from patients is how many eggs are likely to be retrieved and preserved in a single egg freezing cycle. The good news is that this is fairly easy for fertility doctors to predict using two crucial measures: anti-Müllerian hormone (AMH) and antral follicle count (AFC).

AMH and AFC, both estimators of ovarian reserve, can provide an approximation of the number of eggs that can be retrieved from a stimulated cycle. For instance, an AMH level of 15 pmol/L (2.1 ng/mL) could predict a yield of approximately 12 to 18 eggs. Similarly, AFC's numerical value directly correlates with the number of eggs potentially collected in one cycle, with a rough ratio of 1:1. So if your fertility doctor counts 15 antral follicles during the transvaginal ultrasound, you could potentially retrieve 15 eggs in a single cycle (note this number could be lower or higher based on other factors).

Will I have enough eggs to share?

Cofertility’s Split program offers women a chance to freeze their eggs *for free* when donating half of the eggs retrieved to a family who cannot otherwise conceive. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge.

Since the number of eggs is predictable with AMH and AFC, we’re only able to accept people into the program if we are confident they would have enough eggs to “split”. 

Setting expectations 

You can look at the probabilities and hormonal indicators, but everyone’s egg freezing journey is unique. Age, health, lifestyle, and genetic factors can all play a role in your path to motherhood. Remember, egg freezing is a science, but it's not an exact one. The uncertainties are part of the process. And while the prospect of attrition can seem daunting, it's important to remember that every step forward is a step closer to the potential for success.

Navigating these complexities can feel overwhelming, which is why support and guidance are crucial. At Cofertility, our mission is to guide you through this journey, providing you with the necessary information, support, and encouragement to make the best decisions for your fertility future.

Although egg freezing can't offer guaranteed outcomes, it has undoubtedly provided hundreds of thousands of women worldwide with expanded options and increased flexibility in their reproductive timelines. By understanding the process's intricacies and setting realistic expectations, we can navigate this journey together, with optimism, resilience, and hope.

Freeze your eggs with Cofertility

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

Our Split program offers women a chance to freeze their eggs for free when donating half of the eggs retrieved to a family who cannot otherwise conceive. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Read more:

• Should I Freeze Eggs or Embryos?
• Which Matters More for Fertility: AMH or Age?
• Do’s and Don’ts During Egg Freezing: Alcohol, Baths, Exercise, and More

If you’re considering freezing your eggs, you’re probably open to trying just about anything to make your cycle as successful as possible. You’re doing all the things: taking supplements, eating a healthy diet, and being mindful of your lifestyle choices. When it comes to acupuncture, though, you may have heard mixed advice. Can acupuncture really help improve egg freezing outcomes? Let’s find out. 

What exactly is acupuncture, anyway?

Acupuncture is a medical treatment based on the disciplines of traditional Chinese medicine (TCM). It’s built on the theory that there are channels that flow through the body, kind of like the circulatory system. 

When someone goes in for an acupuncture treatment, the practitioner inserts teeny-tiny, stainless steel, disposable needles into the patient’s body at specific points along those channels (typically between eight and twelve points, but sometimes up to twenty). Different points are used depending on any symptoms you might be experiencing — back aches, anxiety, acid reflux...you name it! — and practitioners view the body as totally interconnected. It is considered to be generally painless.

What does acupuncture (supposedly) do?

The goal of acupuncture is to regulate each of your systems to get them to work optimally and in harmony with each other. For example, a 2002 Fertility and Sterility study published by the American Society for Reproductive Medicine (ASRM) indicated that receiving regular acupuncture treatments can regulate patients’ endocrine systems (where sex, mood, and sleep hormones are manufactured). 

Regulating your endocrine system via acupuncture can dial down your stress response, which may be heightened during an egg freezing cycle. But the question remains, will decreased stress translate to improvement in actual egg freezing cycle outcomes, in terms of quantity and quality of eggs?

Egg freezing and acupuncture: what the data says

Remember: beta endorphin levels regulate and balance a woman’s Follicle Stimulating Hormone (FSH) levels, which do impact the ability of her ovaries to grow and mature eggs. So when we see a 1998 Journal of Traditional Chinese Medicine study demonstrate dramatically increased beta endorphins among those who received acupuncture vs. those who hadn’t, that’s worth noting.  

But by and large, when it comes to acupuncture and egg freezing, there’s a lot of misinformation out there. The vast majority of available studies focus primarily on IVF success measures: embryo fertilization, positive pregnancy results, and live births. While embryo fertilization is the primary indicator of egg quality, (though many other factors also contribute to fertilization), only looking at acupuncture’s relationship with IVF outcomes can be problematic, because we are viewing a limited population who already may have fertility challenges. 

Some studies have explored the potential influence of acupuncture on the number of eggs retrieved during ovarian stimulation, the egg freezing phase during which a patient takes injectable hormone medications to stimulate her ovaries to mature more eggs for retrieval and freezing. This is helpful for us to explore, but it’s important to note if those studies are only looking at a population who needs to undergo IVF to conceive, as this is different from the population of those looking to electively freeze their eggs.

All of this being said, there is some data out there that’s worth investigating. 

Stress and fertility

In some cases, we may be able to triangulate studies about acupuncture’s impact upon stress and anxiety with studies about the impact of stress upon egg retrieval outcomes. But we need to acknowledge that these are assumptions and hypotheses, taking a transitive property into account rather than studying the direct impact of acupuncture upon egg retrieval outcomes. 

Even then, when only looking at the impact of stress upon fertility and egg retrieval outcomes (largely related to egg quantity), the data is mixed:

• A 2011 British Medical Journal study noted that “pretreatment emotional distress was NOT associated with treatment outcome” (in this case, it’s important to consider that “outcome” = successful pregnancy and live birth using eggs from that treatment cycle).
• A 2009 Psychological Reports article showed a significant correlation between depression and number of eggs retrieved, with fewer eggs retrieved associated with higher instances of depression.
• A 2001 Fertility and Sterility article stated that “baseline (acute and chronic) stress affected biologic endpoints (i.e., number of oocytes retrieved and fertilized).”
• A 2015 General and Comparative Endocrinology study concluded that increased cortisol levels may cause anovulation in stressed mice.
• A 2016 Journal of Biomedical Science study showed that increased cortisol and oxidative stress levels affect our granulosa cell functions, possibly by inducing apoptosis — which results in changes to our estradiol hormones and egg growth, development, and quality.

Some more direct evidence

While there is lots of (mixed) data out there about the relationship between stress and fertility, and some data about how acupuncture reduces stress, there are a handful of studies that actually look directly at the correlation between acupuncture treatments, number of eggs retrieved, and potential egg quality conclusions based on fertilization and live birth outcomes. It’s important to remember that quantity does not necessarily translate directly to quality. Meaning, there is a chance you could have many eggs and very few (or even zero) could result in a fertilized embryo or pregnancy. The general principle is, the more eggs you retrieve, the greater chances you’ll have of having enough high quality eggs for future use. 

One of the more applicable studies is a 2023 Frontiers in Endocrinology meta-analysis, which looked at seven clinical randomized controlled trials (RCTs) that ultimately included 516 women. Although the quality of those studies may have been questionable, this meta-analysis showed that the use of acupuncture increased the number of eggs retrieved and the antral follicle count, while improving the patients’ estradiol and FSH levels. However, there was no difference in fertilization rate or pregnancy rate. This analysis suggests that acupuncture does not improve the ultimate outcome most egg freezers care about: chances of a healthy baby down the line. 

On the flip side, a 2006 Fertility and Sterility study of 273 women in Denmark showed no statistical difference in the number of eggs retrieved between those who received acupuncture and those who did not. For what it’s worth, this study did, however, show a substantial improvement in pregnancy and live birth rates among those who received acupuncture on the day of their embryo transfer.  

What to expect at your acupuncture appointment

If you’ve decided to move forward with acupuncture, you’ll first need to find a local practitioner. At your first treatment, your acupuncturist will ask you tons of questions about your medical history, just like any Western doctor would. Then they’ll take your pulse and look at your tongue (seriously). 

Here’s what they’re looking for: patterns of disharmony, which may be missed by your regular doctor because they don’t show up as illnesses. Let’s say you have trouble sleeping and you feel anxious and your skin is dry and your hair is falling out. In Chinese medicine, that grouping of symptoms together indicates a “blood deficiency.” It wouldn’t be severe enough for your main doctor to call it anemia, but there may be enough symptoms to show some imbalance is going on in your body. With that information, your acupuncturist can determine where to insert the needles to best address your individual needs.

When it’s time for your treatment, you may be asked to undress and put on a gown or cover yourself with a sheet and lay down or face up on a table, like you’re getting ready for a facial. The practitioner will then reenter the room and begin “tapping” the needles into the points they’ve selected specifically for your needs.

The insertion of the needles doesn’t usually hurt — maybe just a pinch — but it shouldn’t stay painful because the needles are as fine as a strand of hair. If you’re not comfortable, just let your practitioner know and he/she will make an adjustment. Comfort is key. Once all the needles are in, the acupuncturist will leave the room (ideally turning on some music or relaxing white noise) and you’ll rest there on the table for about 30 minutes. You may fall asleep right away, or you may need a couple of sessions to get used to it.

To experience the full desired effects of acupuncture, some practitioners say it could take about 3 months of weekly treatments. Think of it this way: it takes about 100 days for red blood cells or sperm to mature, so according to acupuncturists, if you want acupuncture to make changes in your body’s functioning, you’ll want to give it the time it naturally needs. At the very least, you should leave your treatment feeling like you just got a really good night’s rest.

The TLDR on acupuncture and egg freezing

There’s so much more research to be done regarding the relationship between acupuncture and egg freezing outcomes. But, based on the scouring we’ve done through existing studies, there does not appear to be evidence that acupuncture could directly help your egg freezing experience. Acupuncture cannot influence structural issues, like fallopian tube blockages, for example. 

But while it may not help you retrieve more eggs or increase your chances of pregnancy down the line, it may be something you want to do purely for relaxation. You can think about it like a massage or day at the spa. 

With that in mind, the only nuisances may be appointment scheduling or dealing with insurance to see what’s covered. But, beyond that — the goal of acupuncture is to make your mind and body feel good. So, if you have the time and willingness to pay, we support that! In my case, I’m incredibly lucky; my insurance covers unlimited acupuncture visits throughout the year, including for pain or anxiety (note: I do not believe fertility is a billable reason for my acupuncture coverage). If you’re interested in pursuing acupuncture, it is definitely worth having a conversation with your acupuncture clinic and with your insurance provider. But if you can’t squeeze it in or justify the cost…please do not worry about it. You’ve got enough going on as it is.

Remember, when freezing your eggs with Freeze by Co, our team of medical experts (plus our free member community of others freezing their eggs, just like you!) will be with you every step of the way to answer questions like this and more. Our Split program even offers those ages 21-33 the chance to freeze their eggs for free! With a Split cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. 

If you’re over 34 or not interested in donating half of the eggs retrieved, you can still participate in our Keep program up to age 40. With Keep, you can freeze your eggs and keep them all for yourself, on your timeline while having access to valuable community support. 

Regardless of which path you choose, our team is here to guide you through the process to keep your family-building options on the table.

As you embark on your egg freezing journey, you're likely to encounter a whirlwind of medical terms, tests, and metrics that can feel overwhelming at first. Among these is an especially important one: the Antral Follicle Count (AFC). This key indicator plays a significant role in understanding your chances of success with egg freezing by measuring the number of follicles in your ovaries.

But what exactly is AFC, and why does it matter so much? More importantly, is it a fixed number, or can it change over time? These are questions that many folks grapple with as they navigate egg freezing.

In this article, we'll dive into the world of AFC, demystifying this important metric and exploring its variability. We'll break down the science in a way that's accessible and relevant to your egg freezing journey, helping you understand what your AFC means for your fertility and how it might influence your treatment plan.

Whether you're just starting to consider egg freezing or you're already in the midst of the process, understanding AFC can empower you to make informed decisions about your reproductive future. It's not just about numbers on a chart; it's about gaining insight into your body's unique fertility landscape and working with your healthcare team to optimize your chances of success.

By the end of this article, you'll have a clearer understanding of what AFC is, how it's measured, why it matters, and yes - whether it can change. Armed with this knowledge, you'll be better equipped to navigate your egg freezing journey with confidence and clarity.

What is AFC and how is it measured?

Antral Follicle Count is a key indicator of your ovarian reserve - essentially, it's a snapshot of your egg supply. Whereas AMH measures your ovarian reserve through a hormone blood test, AFC is an actual look at your antral follicles, which are small fluid-filled sacs containing immature eggs. But what is an ovary follicle exactly? An ovary follicle is a structure within the ovary that contains a developing egg. To assess AFC, a fertility doctor performs a transvaginal ultrasound, typically early in your menstrual cycle, to count these follicles in your ovaries.

The number of visible follicles, your AFC, is a helpful predictor of how your ovaries might respond to fertility medications during the egg freezing process. A higher count generally suggests a better ovarian reserve and potentially more eggs that can be retrieved.

Fertility doctors use this information to tailor your treatment plan, determining which medications to use and in what doses. It's like creating a personalized roadmap for your egg freezing journey.

Does AFC change within a cycle?

While it's often recommended to perform the AFC early in your menstrual cycle, experts suggest that it can be assessed at various points. However, it's important to remember that there can be some fluctuation depending on when the ultrasound is done. In fact, studies have shown that AFC can vary by as much as 30-34% within a single cycle. This variability is worth keeping in mind as you interpret your results.

Can AFC change month to month?

Does antral follicle count change? Yes, your AFC isn't set in stone. Indeed, it can vary from one menstrual cycle to the next. This variability is one reason why fertility specialists often consider AFC alongside other markers, like Anti-Müllerian Hormone (AMH) levels, to get a more comprehensive picture of your ovarian reserve.

Remember, AFC correlates with the number of eggs retrieved during an IVF cycle, which is why it's such a valuable predictor for egg freezing outcomes.

A very low AFC (typically less than 5-7) is associated with a smaller number of eggs retrieved and potentially reduced pregnancy rates down the line. On the flip side, a high AFC (20 or more) could indicate a risk of ovarian hyperstimulation syndrome (OHSS) during fertility treatments.

Can I increase my AFC?

While AFC generally declines with age, there are factors that can influence it. For instance, if you're using hormonal contraceptives or certain other medications, your AFC might appear lower than it actually is. Once you stop these medications, you might see an increase in your AFC.

To increase your chances of a successful egg freezing cycle, optimize your fertility health as soon as possible. This step will look a little different from person to person since everyone has their own unique medical history and concerns. Generally speaking though, optimizing your health will include following a balanced diet and making other healthy lifestyle choices. In some cases, you may want to consider adding certain vitamins and supplements to your regimen too. Make sure to talk to your fertility specialist if you’re not sure!

You may also want to consider doing multiple egg retrieval cycles. If you have the resources and time to do multiple cycles, this can vastly improve the pool of eggs to choose from in the future. This is an especially helpful option for people who are older or have a low AFC. If your fertility provider thinks more cycles will improve your chances, they’ll discuss those recommendations with you.

What is a normal AFC by age?

The normal range of antral follicle count can vary depending on your age. In general, those who are younger tend to have a higher number of antral follicles, indicating a larger ovarian reserve. As a person ages, the number of antral follicles naturally declines, reflecting the diminishing ovarian reserve.

While the specific numbers can vary, a typical AFC for someone in their 20s and early 30s may range between 10-20 follicles, in their late 30s around 8-15 follicles, and by their 40s, it could further decline to under 10 follicles. It's important to remember that these numbers are approximate and can vary based on individual factors such as genetics and overall reproductive health.

One study of infertile women looked at exactly how antral follicle count declines with age, finding the median AFC to be:

• 14 at age 25
• 12 at age 30
• 10 at age 35
• 8 at age 40
• 6 at age 45

What does this mean for you?

Understanding the variability of AFC can help you approach your egg freezing journey with realistic expectations. If your first AFC measurement isn't what you hoped for, remember that it can change. Your fertility doctor might recommend retesting in a subsequent cycle or adjusting your treatment plan based on your individual AFC trends.

Remember, AFC is just one piece of the puzzle. Your age, overall health, and other fertility markers all play crucial roles in determining your egg freezing outcomes. The goal is to create a personalized plan that gives you the best chance of success.

As you navigate this process, don't hesitate to ask your fertility doctor questions. Understanding your body and your options is empowering, and it can help you make informed decisions about your fertility preservation journey.

If you just started researching egg freezing, you might feel like you’ve been introduced to a whole new language. Whether clinical in nature or just shortened slang, with egg freezing comes its own terminology. And even if you’ve already educated yourself on what’s involved with egg freezing, chances are, you’ll come across an acronym you’ve never heard of. 

Fear not. Below, you’ll find a comprehensive list of acronyms, abbreviations, and terms you should know when diving into an egg freezing cycle. Read this, and soon you’ll rattle off egg freezing lingo like a pro. 

Hormones and general fertility 

• AMH: One of the first hormones your reproductive endocrinologist will investigate, Anti-Müllerian Hormone is measured early in a woman’s cycle to determine her ovarian reserve. A higher AMH level correlates to a higher ovarian reserve, or in other words, more eggs.
• CD: "Cycle day"—or the day of one's menstrual cycle, with CD1 = the first day of a period. Understanding your cycle length is super important, as it may indicate your most fertile window of dates. It will also help you determine any irregularities to consider as you embark on an egg freezing cycle. 
• DPO: "Days past ovulation." In a typical menstrual cycle, women can expect their period at 14DPO.
• Dx: Diagnosis, the medical identification of a condition or issue affecting fertility, which may impact decisions regarding egg freezing and related treatments.
• E2: Estradiol, a female hormone that's produced by ovarian follicles and determines how well a woman is responding to controlled ovarian hyperstimulation with fertility drugs. If you're freezing your eggs, you’ll have several routine monitoring appointments that include ultrasounds and bloodwork that measures estradiol levels. The higher the estradiol, the more follicles that are likely developing and (fingers crossed) the more eggs that may be retrieved.
• FSH: Follicle stimulating hormone, a hormone released from the pituitary gland to stimulate the ovaries or testicles. When getting an initial fertility workup, you'll get tested for your existing FSH. If you're taking FSH as a drug as part of your egg freezing protocol, it's also known in the United States as Follistim, Gonal-F or Bravelle.
• hCG: Human Chorionic gonadotropin, a hormone produced by an implanting embryo. If this hormone is present in a woman's blood, it indicates a possible pregnancy. It can also be given to women undergoing an egg freezing cycle to trigger ovulation right before a retrieval procedure.
• LH: Luteinising Hormone, a hormone released by the pituitary gland to stimulate the gonads (ovaries and testicles). If you're freezing your eggs, you'll have levels of this hormone measured often via bloodwork in order to determine ovulation timing.
• LMP: "Last menstrual period," or the start date of a woman's last menstrual period.
• MII: Metaphase II, the stage of egg maturation where the egg is ready for (hypothetical) fertilization, with chromosome alignment necessary for successful embryo development.
• PCOS: "Polycystic ovarian syndrome," a condition where the ovaries develop many small cysts, which results in irregular periods and ovulation. It can contribute to future infertility, so if you know you have PCOS, regardless of whether you’re freezing your eggs or not, chat with a reproductive endocrinologist to ensure a safe and healthy plan.
• TSH: Thyroid stimulating hormone, a hormone produced by the pituitary gland meant to stimulate the release of thyroid hormone by the thyroid gland. Recent research has suggested that slightly low TSH may associate with fertility challenges.

Egg freezing 

• AFC: “Antral follicle count,” a count of the number of small follicles in a woman's ovaries, seen via ultrasound early on in her cycle. Used to measure ovarian reserve, you'll have a lot of these if you're freezing your eggs to monitor how you're responding to ovary-stimulating medication.
• ART: “Assisted reproductive technology,” including any procedure involving egg retrievals and manipulating eggs and sperm outside the body. It includes things like egg freezing, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), and zygote intrafallopian transfer/tubal embryo transfer (ZIFT/TET). 
• BCP: Birth control pills. If you’re freezing your eggs, your doctor may prescribe these as part of a medicated cycle in order to regulate the timing
• COH: “Controlled ovarian hyperstimulation,” when several follicles mature simultaneously in response to fertility drug treatment. The key word here is controlled. Your follicle growth will be carefully monitored by your doctor, who will adjust your medication protocol accordingly to stimulate or halt further growth.
• ER: "Egg retrieval" — not "emergency room!" An ER will be performed as part of an egg freezing cycle, and may also be referred to as a VOR (“Vaginal Oocyte Retrieval”).
• IM: Intramuscular, a method of injecting medication directly into a muscle. This method is often used for hormone treatments during the egg freezing process.
• OC: “Oocyte Cryopreservation,” which is another term for egg freezing. 
• OHSS: “Ovarian hyperstimulation syndrome,” a condition where the ovaries become excessively swollen and painful due to the overproduction of eggs from fertility medications. This is very rare, but can happen.
• REI: "Reproductive endocrinologist," or a doctor who specializes in treating male and female fertility.
• SD1: “Stimulation Day 1,” or the first day of medication administered to stimulate the ovaries for egg production during the egg freezing process.
• SQ: Subcutaneous (also abbreviated as SC), a method of injecting medication into the fatty tissue just under the skin, commonly used for administering fertility hormones during an egg freezing cycle.
• TVUS: “Transvaginal Ultrasound,” an imaging technique used to visualize the ovaries and follicles internally, providing information about egg development and ovarian health. If you’re undergoing an egg freezing cycle, you’ll have a lot of these, but they are quick and painless. 

Egg donation

• DE: “Donor eggs,” or eggs provided by another woman to be fertilized with sperm and transferred to the uterus of an intended parent or gestational carrier.
• IP: “Intended parent,” which is a person who becomes the legal parent of a child born through third party reproduction.

If you’re feeling totally overwhelmed by all that’s involved with egg freezing, we’ve got you covered. Take our quiz to see how you may qualify for our more accessible egg freezing opportunities, including our Split program, through which you can freeze your eggs for free when you donate half to another family who can’t conceive. 

We’re wishing you the best of luck on your egg freezing journey!