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Infertile patients cannot afford to wait for treatment while their eggs get older.

Dr. Sherman Silber, Infertility Center of St. Louis, is offering video consultations for patients who need to plan now for their treatment while stay-at-home orders are in place. He is talking to and evaluating patients in their home to comply with social distancing measures.

Dr. Silber is discovering that patients actually prefer this method of telemedicine consultation over the conventional office visit. Patients have conveyed that “it is so much more convenient and less stressful” to have a telemedicine personal consultation than to take a day off from work to travel to the doctor’s office and sit with other nervous patients in the waiting room.

The COVID-19 pandemic is thus changing much of the way we will do things in the future, and for the better. “Our patients are surprisingly much happier with this approach. Of course, at some point we need to perform hands on treatment. But with this new manner of seeing patients, we can come to the right diagnosis and treatment plan for most patients more efficiently, quickly, and painlessly, with no loss of personal one-on-one communication.” This is a very welcome new era of telemedicine that has been forced on us by the current difficult times.

Beating Your Biological Clock: Antrical Follicle Studies

Antrical Follicle Studies

Transvaginal ultrasound is a simple, routine procedure (available everywhere) for viewing the ovaries, utilizing ultra-high-frequency sound waves. A probe (which is smaller than the speculum used for your standard pelvic exam and Pap smear) is placed in the vagina, and a clear image of your ovaries and uterus can be plainly seen (see fig. 7).

FIGURE 7: Side view of ultrasound probe in vagina during routine pelvic exam.
FIGURE 7: Side view of ultrasound probe in vagina during routine pelvic exam.

Antral Follicle Count and Your Age

Transvaginal ultrasound can thus provide an accurate measurement of the total number of antral follicles at any time in your menstrual cycle, and will indicate readily your ovarian reserve and your reproductive future.

Such information would be of great help to young patients, who could relax somewhat about their biological clock if they knew they had a comparatively large ovarian reserve.

FIGURE 8: Number of eggs retrieved in IVF cycle in relation to antral follicle count.

Antral Follicle Count and Your Remaining Years of Fertility

The reliability of antral follicle count is completely independent of the menstrual cycle. Unlike hormone evaluations, the ultrasound evaluation of antral follicle count can be used on any day of the menstrual cycle to show those follicles that have left the resting state and have reached the antral size. This is a daily event that occurs independently of all the other monthly variations in the menstrual cycle.

Antral follicle count can, of course, be used for counseling infertile women about to undergo IVF so that they will know what their chances are for a successful result. However, it is also extremely useful for all women who are thinking about getting pregnant either sooner or later, and who need to know if it is risky for them to put this decision off. It is even possible to predict at what age menopause will occur. Fertile women who have an antral follicle count of twenty to forty, regardless of age, can anticipate becoming infertile within ten to fifteen years and will likely reach menopause about ten years later. An otherwise fertile woman whose antral follicle count is only ten is likely to become infertile very soon, and to have menopause within about thirteen years. Women who have antral follicle counts of less than five are very unlikely to be able to get pregnant with or without infertility treatment, and they are likely to have menopause begin sometime within the next seven to eight years. Of course, these are average and median figures, and cannot predict exactly for each individual patient. But it can be concluded that even younger women with antral follicle counts of less than ten (total from both ovaries) have no time to waste if they want to have children.

Thus, transvaginal ultrasound, which should be a simple and readily available tool in most gynecologists’ offices and certainly in any radiology imaging center, as well as blood AMH levels, can provide an accurate and reproducible measurement of the total number of antral follicles throughout the menstrual cycle, which is indicative of the woman’s ovarian reserve and her reproductive future.

FIGURE 9: Decline of antral follicle count with increasing age of a woman.
FIGURE 9: Decline of antral follicle count with increasing age of a woman.

If you have any questions, you may call us at  (314) 576-1400.


Beating Your Biological Clock

Click Here to download Beating Your Biological Clock in PDF format.

by Sherman J. Silber