When it comes to planning an IVF cycle, there are three crucial factors that often shape the medical approach: a woman’s age, her Anti-Müllerian Hormone (AMH) levels, and her Antral Follicle Count (AFC). Together, they offer a clear picture of ovarian reserve – the number of eggs a woman has available at a given point in time, says Dr Rakhi Goyal, Fertility Specialist, Birla Fertility & IVF, Chandigarh.
AMH is produced by small ovarian follicles. A simple blood test can measure its levels, and lower values usually signal a reduced ovarian reserve, which often means the ovaries may not respond as well to stimulation. AFC, on the other hand, is assessed through a baseline transvaginal ultrasound. Here, the doctor counts follicles between 2–10 mm in diameter. A lower count similarly suggests fewer available eggs.
In treatment planning, these indicators matter because ovarian reserve declines naturally with age, especially after 35. A woman with lower AMH and AFC, combined with older age, is likely to have a more modest response to stimulation. In such cases, the medication dose may be adjusted upward, alternative stimulation protocols may be considered, and additional therapies could be introduced to improve response. Patients are also counselled on realistic success rates.
The opposite scenario is equally important to manage. Women with high AMH and AFC, as often seen in polycystic ovary syndrome (PCOS), are at risk of over-responding to stimulation. Here, doctors plan lower doses and take precautions to avoid ovarian hyperstimulation syndrome (OHSS), a potentially serious complication.
By assessing age, AMH, and AFC together, fertility specialists can create a personalised IVF strategy – one that balances effective stimulation with safety, while giving patients a clear understanding of what to expect. It’s a tailored approach that can make all the difference between a generic plan and one optimised for an individual’s biology.
