When we have a first consultation in assisted reproduction, we need to know what the patient's ovarian reserve is.
This reserve can be determined very easily by performing a transvaginal ultrasound in the first days of the cycle. In this way we can count the number of antral follicles (AFR) contained in each ovary, considering the presence of 6-8 follicles per ovary as normal.
In the same way, we perform a hormone blood test to know the values of Antimullerian Hormone (AMH) which should be found in values above 1.2 ng/mL. This hormone is produced in the granulosa cells that form the follicles, so the more follicles there are, the higher the blood levels will be.
Therefore, when there is a count of 4 follicles or less per ovary or a total of 7 follicles between the two ovaries confirmed by ultrasound and AMH levels below 1 ng/mL the diagnosis would be a low ovarian reserve.
In principle, it would not be possible to have a high AMH and a low AFC However, sometimes we may encounter this situation. If this were to happen, we would be guided by what we have evidenced in the ultrasound at the time of defining how the ovarian reserve is at the time of doing the AFC.