AMH vs AFC : Which Test Predicts Fertility Better?

Fertility can feel like a mystery. Many couples trying to conceive are often left wondering, “Do I have enough eggs? Am I fertile?” If you’re in this boat, you’ve probably heard about two key tests: AMH (Anti-Müllerian Hormone) and AFC (Antral Follicle Count). Both are used to assess ovarian reserve, but which one truly predicts fertility better?

In this article, we’ll break down these tests in a simple, relatable way, compare their strengths and weaknesses, and help you understand how they fit into your fertility journey. By the end, you’ll feel empowered to make informed decisions about your reproductive health.

Understanding Fertility and Ovarian Reserve

Before diving into the tests, it’s important to understand the concept of ovarian reserve. Think of your ovaries like a bank of eggs. Each woman is born with a finite number of eggs, and over time, this number declines.

Two main factors affect fertility:

1. Egg quantity – How many eggs are left in your ovaries.
2. Egg quality – How healthy those eggs are, which naturally declines with age.

AMH and AFC primarily measure egg quantity, giving a snapshot of your ovarian reserve. But neither can directly measure egg quality, which is why age and other health factors still play a major role.

What is AMH?

AMH (Anti-Müllerian Hormone) is a hormone produced by the small follicles in your ovaries. These follicles contain immature eggs, and the level of AMH in your blood reflects how many eggs you may have left.

Why AMH Matters

• AMH provides a quick, convenient estimate of your ovarian reserve.
• It doesn’t fluctuate during your menstrual cycle, so the test can be done any day.
• It’s especially useful for women planning pregnancies later in life or considering fertility treatments like IVF.

What AMH Can Tell You

• Low AMH: May indicate fewer eggs, suggesting diminished ovarian reserve.
• High AMH: Often indicates a larger number of remaining eggs; however, it could also point to conditions like PCOS (Polycystic Ovary Syndrome).

Important: AMH measures quantity, not quality. So even with high AMH, age-related decline in egg quality can affect fertility.

What is AFC?

AFC (Antral Follicle Count) is a test performed via transvaginal ultrasound. During the early days of your menstrual cycle (Day 2–5), a fertility specialist counts the number of small follicles (2–10 mm) in your ovaries.

Why AFC Matters

• Provides a visual count of eggs ready to develop in that cycle.
• Can identify ovarian abnormalities such as cysts or fibroids.
• Highly useful for fertility treatment planning, especially IVF.

What AFC Can Tell You

• A low AFC indicates fewer follicles and a potentially lower response to fertility treatments.
• A high AFC may indicate a strong response to stimulation but could also suggest PCOS.

Tip: Unlike AMH, AFC is operator-dependent accuracy depending on the skill of the ultrasound technician or doctor.

AMH vs AFC : Head-to-Head

Feature	AMH	AFC
Type of Test	Blood test	Ultrasound
Timing	Any day of cycle	Early cycle (Day 2–5)
Measures	Egg quantity	Egg quantity + ovarian structure
Convenience	Easy, one blood draw	Requires clinic visit and ultrasound
Best Use	Early fertility assessment, IVF planning	Detailed ovarian evaluation before fertility treatment
Accuracy	Consistent but may vary by lab	Highly accurate but operator-dependent

Key Insight: Both tests estimate egg quantity, but AFC provides a real-time visual assessment, while AMH offers a convenient hormonal snapshot.

How Reliable Are These Tests in Predicting Fertility?

It’s important to remember: No test can predict fertility with 100% accuracy. Fertility depends on many factors, including:

• Egg quality: Age-related decline can’t be fully measured by AMH or AFC.
• Hormonal health: Imbalances can affect ovulation and conception.
• Uterine and reproductive health: Conditions like fibroids, endometriosis, or blocked tubes impact fertility.
• Male factor fertility: Sperm health is equally important.
• Lifestyle factors: Weight, diet, stress, and smoking affect reproductive health.

Bottom line: AMH and AFC are guides, not guarantees. They help estimate ovarian reserve but do not guarantee conception.

When Should You Get Tested?

Knowing the right timing can help maximize the accuracy of these tests:

• AMH: Can be tested anytime, making it convenient for a preliminary fertility check.
• AFC: Best performed on Day 2–5 of your cycle to get an accurate count of follicles.

Scenarios for testing:

• You’re planning pregnancy later in life.
• You have irregular menstrual cycles or PCOS.
• You’re considering IVF or fertility treatments.
• You want a baseline understanding of your ovarian reserve.

AMH and AFC Together : A Powerful Combo

Many fertility specialists recommend using both AMH and AFC for a complete picture:

• AMH: Gives a general idea of egg quantity and ovarian reserve.
• AFC: Provides real-time insight into follicle development and ovarian structure.

Together, these tests allow doctors to personalize fertility treatment plans, optimize IVF medication doses, and set realistic expectations.

AMH vs AFC in IVF

For couples considering IVF, knowing your ovarian reserve is critical for success:

• AMH helps: Predict the number of eggs that may be retrieved.
• AFC helps: Adjust fertility medication doses and monitor follicle development.

Using both tests together gives fertility specialists the best chance to tailor treatment and improve outcomes.

Real-Life Example

Consider two women, both 32, trying to conceive:

• Woman A: High AMH, AFC shows 15 follicles. She is likely to respond well to fertility treatment.
• Woman B: Low AMH, AFC shows only 4 follicles. She may need specialized treatment to maximize success.

Even though both are the same age, their fertility outlook is different, showing why a combination of tests and personalized guidance is essential.

Key Takeaways

1. AMH measures egg quantity, can be done any day, and is highly convenient.
2. AFC measures egg quantity and ovarian structure, best performed early in the cycle.
3. Neither test predicts fertility alone, but together they provide a comprehensive assessment.
4. Egg quality and age remain crucial factors.
5. For IVF or advanced fertility planning, using both tests together is the most effective approach.

Final Thoughts

Understanding your ovarian reserve is empowering. AMH and AFC are valuable tools, but they are pieces of the puzzle, not the complete picture. Fertility is complex and depends on many factors beyond just egg quantity.

The takeaway: Start early, get tested if needed, Knowledge and timely action can help you take control of your fertility journey and plan for a successful pregnancy.