AMH and antral follicle count are useful markers of ovarian reserve, but they do not measure exactly
how an ovary will behave once IVF stimulation begins. A woman can have a reassuring AMH and a
good number of antral follicles on ultrasound yet develop fewer mature follicles or retrieve fewer
eggs than expected during a particular cycle.
This difference is important because ovarian reserve and ovarian response are related, but they are
not the same thing, says Dr Aashita Jain, Fertility Specialist, Birla Fertility & IVF, Surat.
What AMH and AFC can actually tell us
AMH and antral follicle count help estimate the pool of follicles available in the ovaries and give the
fertility specialist a starting point for planning stimulation.
They are useful predictors of how the ovaries may respond, but they cannot tell us the exact
number of follicles that will grow, how evenly they will develop or how many mature eggs will finally
be retrieved.
Why might the IVF response be different?
Several factors can influence how the ovaries respond to stimulation:
● Individual response: Sensitivity to fertility medicines can vary, even between patients with
similar AMH levels.
● Age: Age and egg quality can influence IVF outcomes beyond the number of eggs available.
● Previous ovarian surgery: Surgery involving the ovaries may affect ovarian response in
some patients.
● Hormonal factors: Underlying hormonal or endocrine conditions can influence how
stimulation progresses.
● Stimulation protocol: The medication dose and protocol may need to be tailored according
to the individual's response.
This is why two women with similar AMH, and antral follicle counts can have very different IVF
experiences.
What happens if the response is unexpectedly low?
A lower-than-expected response in one cycle does not automatically mean that the ovarian reserve
was assessed incorrectly. It also does not mean that every subsequent cycle will have the same
response.
The stimulation cycle itself provides valuable information. The number of follicles that develop, how
they grow during monitoring and how many eggs are ultimately retrieved can help the fertility
specialist understand the ovarian response and decide whether the treatment approach needs to be
reconsidered.
Why is it important to look at both the reports and the actual response?
Baseline reports provide useful information before treatment, but they cannot capture every factor
that influences an individual IVF cycle. The body's response to stimulation adds another important
layer to the assessment.
A good ovarian reserve does not guarantee a specific number of eggs, just as a lower-than-expected
response in one cycle does not define future IVF outcomes. Looking at the initial assessment
alongside the actual treatment response allows the fertility specialist to make more informed
decisions and, where needed, develop a more individualised plan for the next IVF cycle.
