Clomid alternatives: what works and when to pick each option
If Clomid (clomiphene) hasn't worked for you or causes bad side effects, you’ve got options. Some choices are simple pills, others are injections or procedures. The right one depends on why you’re not ovulating, your age, and how quickly you want results. Below I’ll walk through the most used alternatives and when they make sense.
Main medical alternatives
Letrozole (Femara) — This is the most common alternative to Clomid, especially for people with PCOS. Letrozole is an aromatase inhibitor that can trigger ovulation and often produces thicker uterine lining than Clomid. Many fertility clinics now use letrozole first for PCOS because trials showed higher live-birth rates in that group. It’s taken for a few days early in the cycle and usually monitored with ultrasound or ovulation tests.
Gonadotropin injections (FSH/LH) — These are injectable hormones that stimulate the ovaries directly. They work when oral meds fail, but they require clinic visits for monitoring and carry higher risks for ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. In other words: more chance of success, plus more monitoring.
Tamoxifen — Used less often than letrozole, tamoxifen can be an option if Clomid isn’t suitable. It’s another oral drug that can help trigger ovulation, but most clinics prefer letrozole first now.
Other options and practical steps
IVF (in vitro fertilization) — IVF bypasses many ovulation issues and is the go-to when other methods fail or if there are additional factors like blocked tubes or severe male factor infertility. It’s the most effective route but also the most expensive and time-consuming.
Metformin and lifestyle changes — If PCOS is the main problem, adding metformin (for insulin resistance) or losing even 5-10% of body weight can restore regular cycles and improve response to fertility drugs. These are low-tech but often impactful steps.
Surgical options — Laparoscopic ovarian drilling is rarely used now but can help some people with PCOS who don’t respond to medication. It’s a minor surgery and usually considered only after drugs fail.
Intrauterine insemination (IUI) — Often paired with oral meds or injections, IUI moves sperm directly into the uterus and can boost chances without jumping straight to IVF.
Before switching or trying anything new, get basic tests: ovulation tracking, AMH or antral follicle count for ovarian reserve, thyroid, and prolactin. These tests help tailor the next step.
If you’re feeling stuck, ask your provider about a fertility clinic referral. A specialist can outline risks, monitoring needs, and likely success rates for each option. And remember: monitoring matters—fertility drugs without ultrasound and blood checks increase risks and reduce safety.
Want a quick checklist to take to your appointment? Note your cycle history, any previous drug doses and responses, PCOS or other diagnoses, and how long you’ve tried. That makes the next treatment choice clearer and faster.
