Clomid alternatives: practical options for ovulation and fertility

If Clomid (clomiphene) didn’t work for you or caused bad side effects, there are clear alternatives to try. Some options are drugs with similar goals, others are lifestyle or assisted-reproduction choices. I’ll lay out the main paths so you can talk with your doctor more clearly.

Medical alternatives

Letrozole (Femara) is the most common alternative. It’s an aromatase inhibitor that helps eggs develop by lowering estrogen briefly. For people with PCOS, several studies found letrozole often produces higher live-birth rates than Clomid and fewer thin uterine-lining problems. Doctors frequently try letrozole first when Clomid fails.

Injectable gonadotropins (FSH or hMG) are stronger. They directly stimulate the ovaries and are used when oral drugs don’t work. These require close monitoring with blood tests and ultrasound because they raise the risk of multiple pregnancies and ovarian hyperstimulation, but they’re effective when timed with IUI or IVF.

Metformin isn’t an ovulation drug by itself, but it helps many people with insulin resistance or PCOS. Combined with letrozole or Clomid, metformin can restore regular cycles and improve chances of ovulation in some cases.

Tamoxifen is an older alternative sometimes used when Clomid causes poor uterine lining. It works differently and may be an option when preserving the endometrium matters.

Non-medical and assisted options

Lifestyle changes matter more than people expect. If you have overweight or obesity, losing 5–10% of body weight can restore ovulation in many with PCOS. Stop smoking, cut excess alcohol, improve sleep and manage stress—these steps can boost natural fertility and medication response.

Supplements: folic acid is essential before and during attempts to conceive. For PCOS, myo-inositol has decent evidence for improving ovulation and egg quality. Don’t rely on supplements alone; use them alongside medical advice.

If medication options don’t work, assisted methods move up: intrauterine insemination (IUI) combined with ovulation drugs, or in vitro fertilization (IVF). IUI is less invasive and cheaper than IVF but gives lower success for some causes of infertility. IVF bypasses many issues and allows precise control over timing and embryo quality.

Safety first: any fertility drug should be used under medical supervision. Monitoring reduces risks like ovarian hyperstimulation and multiple pregnancy. If you have medical conditions—thyroid disease, high prolactin, or severe insulin resistance—treating them often improves ovulation results.

Which route is best depends on why you’re not ovulating, your age, partner factors, and your tolerance for risk. Bring clear questions to your fertility doctor: Why did Clomid fail? Is letrozole a good next step? Do we need blood tests or an ultrasound cycle? That makes decisions faster and safer.

If you want, I can summarize the pros and cons of letrozole, gonadotropins, metformin, and IVF side-by-side for your situation. Tell me your diagnosis or concerns and I’ll make a short comparison you can print and bring to your appointment.