Follicle Count and Ovarian Function in Women Over 35

Follicle count

Hello Doctor: I will be turning 38 this year and am preparing for my first pregnancy.
After several months of trying, I have not been successful.
This time, on the second day of my menstrual cycle, I had a transvaginal ultrasound, which showed three follicles on the left and three on the right.
The doctor mentioned that my ovaries are somewhat small, which may indicate reduced ovarian function.
I would like to ask, is this number of follicles considered low? Thank you, Doctor.

Xiao Miao, 30~39 year old female. Ask Date: 2011/06/29

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello, usually during menstruation, the follicles are just beginning to prepare for growth, so it is possible that not a single follicle is visible at this time.
Therefore, there is no need to worry about the number of follicles at this stage; please be patient and wait until just before ovulation.
If mature follicles can be seen at this time, it indicates that ovarian function is normal.
The size of the ovaries is not very important.
Some patients may need to have part of their ovaries removed for various reasons, yet they can still conceive successfully.
Research reports from abroad indicate that retaining just one-third of an ovary is sufficient for ovulatory function.
Wishing you peace and health.
Sincerely, Dr.
Lu Li-Cheng, Director of the Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2011/06/29

More Info

Understanding follicle count and ovarian function is crucial for women over 35 who are trying to conceive. As women age, particularly after the age of 35, fertility tends to decline due to a decrease in both the quantity and quality of eggs. This decline can be influenced by various factors, including hormonal levels, ovarian reserve, and overall reproductive health.

In your case, you mentioned that during a transvaginal ultrasound on the second day of your menstrual cycle, three follicles were observed on each ovary. It’s important to note that during the early follicular phase of the menstrual cycle, it is common for the number of visible follicles to be low. Follicles are in various stages of development, and not all will mature into eggs that can be ovulated. Typically, during this phase, the ovaries are just beginning to prepare for ovulation, and it is not unusual for only a few follicles to be seen.

The size of your ovaries and the number of follicles can provide some insight into ovarian function. While your doctor mentioned that your ovaries are smaller than average, it is essential to understand that ovarian size alone does not determine fertility. Research indicates that even women with smaller ovaries can conceive successfully, provided they have a sufficient number of healthy eggs. The key factor is the ovarian reserve, which can be assessed through various tests, including Anti-Müllerian Hormone (AMH) levels, Follicle Stimulating Hormone (FSH), and estradiol levels.

Regarding your question about whether three follicles on each side is considered low, it is relatively normal for the early phase of the cycle. However, if you are concerned about your ovarian function, it may be beneficial to discuss further testing with your healthcare provider. Tests such as AMH levels can give a better indication of your ovarian reserve and help assess your fertility potential.

In addition to follicle count, other factors can influence your chances of conception, including lifestyle choices, overall health, and any underlying medical conditions. For instance, conditions such as polycystic ovary syndrome (PCOS) or endometriosis can affect ovulation and fertility. If you have any concerns about your menstrual cycle or reproductive health, it is advisable to consult with a fertility specialist who can provide personalized guidance and treatment options.

Lastly, patience is crucial when trying to conceive, especially as you approach 38. Many women in their late 30s successfully conceive, but it may take longer than expected. If you have been trying for several months without success, consider tracking your ovulation and menstrual cycle closely, as this can help identify your most fertile days. Additionally, maintaining a healthy lifestyle, managing stress, and seeking support from healthcare professionals can also enhance your chances of conception.

In summary, while the number of follicles observed during your ultrasound may seem low, it is not uncommon for the early follicular phase. Ovarian function is multifaceted, and further evaluation of your ovarian reserve and overall reproductive health may provide more clarity. Consulting with a fertility specialist can help you navigate this journey and explore your options for conception.

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