Ideal Estradiol and LH Levels on Day 8 of Menstrual Cycle During Menopur Treatment
For women undergoing fertility treatment with Menopur on day 8 of the cycle, target estradiol levels of 400-650 pg/mL are associated with the highest live birth rates, while LH levels should remain detectable but suppressed if using GnRH antagonist protocols. 1
Estradiol Targets on Day 8
Optimal Range for Fertility Outcomes
- Estradiol levels between 400-650 pg/mL on day 8 correlate with the best live birth rates (37.8%) in antagonist protocols 1
- Levels below 400 pg/mL significantly reduce live birth probability (OR: 0.752, p = 0.048), with only a 28.9% live birth rate 1
- Levels between 650-800 pg/mL also reduce live birth rates (26.4%) compared to the optimal range (OR: 0.595, p = 0.011) 1
- Early estradiol monitoring (day 4) shows that levels >75 pg/mL predict better pregnancy outcomes (42.3% vs 9.1% clinical pregnancy rate), suggesting progressive rise through day 8 is favorable 2
Physiologic Context
- Normal early follicular phase estradiol ranges from 31-771 pmol/L (approximately 8-210 pg/mL), but controlled ovarian stimulation intentionally exceeds this 3
- In natural cycles, day 8 falls within the late follicular phase when estradiol begins rising toward the mid-cycle peak 3
- The correlation between estradiol and birth rate increases progressively, with optimal outcomes requiring mild ovarian hyperstimulation rather than minimal stimulation 4
LH Level Considerations on Day 8
LH Activity with Menopur
- Menopur contains both FSH (75 IU) and LH (75 IU) activity per ampoule, providing exogenous LH supplementation 5
- Treatment with LH-containing menotropins results in shorter treatment duration (12.6 vs 16.1 days) and lower total medication consumption compared to FSH-only protocols 5
- The presence of LH activity reduces development of small non-dominant follicles (<10 mm) and optimizes folliculogenesis 5
Expected LH Levels
- In GnRH agonist-suppressed women receiving menotropins, endogenous LH remains suppressed while exogenous LH activity drives follicular development 5
- Serum LH area under the curve is higher in menotropin-treated cycles compared to pure FSH, reflecting the exogenous LH contribution 5
- Specific numeric LH targets are less critical than ensuring adequate LH activity is present through the menotropin formulation itself 5
Monitoring Algorithm for Day 8
Assessment Parameters
- Measure serum estradiol on day 8 to confirm levels are within the 400-650 pg/mL optimal range 1
- Perform transvaginal ultrasound to count follicles ≥12 mm, as follicle number correlates with birth rate (r = 0.140, p < 0.001) 4
- Target 4 or more follicles ≥12 mm for optimal pregnancy rates (25.8% birth rate in women <35 years) 4
Dose Adjustment Considerations
- If estradiol <400 pg/mL on day 8, consider increasing Menopur dose to achieve adequate stimulation 1
- If estradiol >650 pg/mL on day 8, consider reducing dose to avoid the suboptimal 650-800 pg/mL range 1
- The fixed regimen approach (2 ampoules daily for 14 days) with menotropins shows good outcomes, but individualized adjustments after initial monitoring improve results 5
Common Pitfalls to Avoid
Estradiol Interpretation Errors
- Never interpret estradiol levels in isolation without correlating with follicle count and cycle day 6
- Avoid assuming higher estradiol always means better outcomes; levels >650 pg/mL show reduced live birth rates 1
- Do not use natural cycle reference ranges (31-771 pmol/L early follicular) as targets during controlled stimulation 3
LH Monitoring Misconceptions
- Do not attempt to replicate natural mid-cycle LH surge timing on day 8; this occurs later in stimulated cycles 3
- Avoid switching from menotropins to pure FSH based solely on LH levels, as the LH activity in Menopur provides therapeutic benefit 5
- Do not confuse the Standard Days Method (days 8-19 for fertility awareness) with hormone monitoring in IVF protocols 7