Inside the Tests – What AMH and Antral Follicle Count Really Tell You
Welcome to Part 2 of our fertility testing series. In the first post, we talked about how there’s no single “fertility test,” but rather a few different indicators — most notably AMH and antral follicle counts — that help you understand your ovarian reserve.
Now we’re going to dive deeper into what these tests involve, how they work, and how to interpret them without losing your mind.
What Is Ovarian Reserve?
Think of your ovarian reserve as a bank account of eggs. You're born with all the eggs you'll ever have. Over time, this supply naturally declines, especially after age 35. When we talk about “testing fertility,” we’re usually talking about trying to get a sense of how many eggs are left in that bank — that’s your ovarian reserve.
To assess this, most professionals use two main tools:
The AMH Test: Your Hormonal Estimate
AMH stands for Anti-Mullerian Hormone. Every egg in your ovaries gives off a bit of this hormone. So, in theory, the more AMH in your blood, the more eggs you’ve got.
How it works: It’s a simple blood test — no special timing needed in your cycle.
What it tells you: A high AMH level generally means you have a higher ovarian reserve. A low AMH means your reserve may be declining.
But: It doesn’t measure egg quality. Results can vary between labs and are best interpreted in context — ideally alongside other tests and your age.
The Antral Follicle Count: Your Snapshot in Real Time
The Antral Follicle Count (AFC) is a count of the small follicles in your ovaries at the start of your cycle. These follicles each contain an immature egg.
How it works: It’s done via a transvaginal ultrasound, usually between Days 3 and 5 of your menstrual cycle.
What it tells you: The more follicles you have, the more active your ovaries appear to be that month. This correlates with a higher ovarian reserve.
Yes, it’s a bit awkward — but not painful — and definitely worth doing.
Why You Need Both
AMH gives a hormonal picture, while AFC gives a visual one. Sometimes they align; sometimes they don’t. A woman might have a low AMH but still have plenty of follicles on scan, or vice versa. That’s why fertility specialists usually recommend doing both tests to get a fuller picture.
What About Hormone Testing?
Beyond AMH and AFC, many people also look at other hormone levels — like FSH, LH, and estradiol — to understand more about how the reproductive system is functioning. This can be especially helpful if your AMH or AFC results are surprising.
A Word on Egg Quality
None of these tests can tell you about egg quality. That’s a major limitation, because quality matters just as much — if not more — than quantity. Age is the biggest factor in egg quality, but lifestyle choices (like smoking, diet, alcohol, and sleep) also play a role.
Summary
AMH estimates how many eggs you might have.
AFC shows how many follicles are visible this cycle.
Hormone tests can help explain odd results.
Egg quality is separate — and mostly age/lifestyle-based.
