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Antral Follicle Count Calculator

Enter the antral follicle count of each ovary to get the total AFC and the PCOM check.

How it is calculated

The tool adds the two counts from the ultrasound report: total AFC = left ovary + right ovary. For the PCOM check it takes the larger of the two counts and compares it with the threshold of the 2023 International Evidence-based Guideline for PCOS (recommendation 1.4.4): PCOM threshold met if max(left, right) ≥ 20. Both counts must be whole numbers from 0 to 200; a decimal, negative or larger entry gives no result. The threshold is for adults scanned with transvaginal ultrasound that can count follicles through the whole ovary; with older equipment or a transabdominal scan the guideline uses ovarian volume (10 ml or more) or follicles per section instead, which this tool does not compute. No low or normal reserve band is shown, because no guideline sets one cut-off for that. The result is not medical advice.

Worked example

An ultrasound report lists 6 antral follicles in the left ovary and 8 in the right ovary. Total: 6 + 8 = 14 follicles, shown with the split 6 left + 8 right. Neither ovary has 20 or more, so the PCOM check reads Below PCOM threshold. With 11 and 10 follicles the total is 21, but each ovary is still under 20, so the threshold is not met; with 22 in one ovary and 4 in the other it is. Your clinician interprets the count together with age, AMH and the other PCOS features.

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Common mistakes

  • Entering the total in one box and zero in the other. The total is still right, but the PCOM check then reads the whole total as one ovary; enter each ovary separately.
  • Reading a total of 20 or more as PCOM. The guideline counts each ovary on its own, so 11 + 10 does not meet the threshold.
  • Typing the follicle size in millimetres instead of the count, or a range such as 5-8. Only whole numbers are accepted.
  • Reading “PCOM threshold met” as a PCOS diagnosis. PCOS needs two of three features (irregular cycles, high androgens, polycystic ovaries), and ultrasound criteria are not used in adolescents.
  • Comparing counts from different cycle days or scans as one figure; one count reflects one scan.

Sources

About this calculator

An antral follicle count (AFC) is an ultrasound count of the small antral follicles (about 2–9 mm) in each ovary, usually done early in the menstrual cycle by transvaginal ultrasound. The total of both ovaries is one of the main markers fertility specialists use, together with AMH (anti-Müllerian hormone), to estimate ovarian reserve and to predict how a patient will respond to stimulation in IVF: a higher count generally means more eggs retrieved, a low count suggests reduced reserve. There is no single guideline cut-off for a low or normal count; clinics read it together with age and AMH, so this tool shows the total without a reserve label.

The count per ovary also matters for polycystic ovarian morphology (PCOM). The 2023 International Evidence-based Guideline for PCOS sets the threshold at a follicle number per ovary of 20 or more in at least one ovary in adults, counted with modern transvaginal ultrasound; the two-ovary total is not used. The tool checks each ovary against that threshold. PCOM is only one of the three diagnostic features of PCOS (with irregular cycles and high androgens, two of which are needed), ultrasound is not recommended for this in adolescents, and the result is for reference only, not medical advice.

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  • Editorial team

    This tool applies the per-ovary threshold of the 2023 international PCOS guideline to the larger of the two counts. Older papers and some reports quote a different cut-off, so check which guideline and year a document cites before comparing numbers. The tool shows a count check, not a diagnosis, and a clinician reads it alongside age, hormones and symptoms. If your report uses another cut-off, tell us which guideline it cites.

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