Clomid alternatives: what actually works for ovulation

Clomid (clomiphene) has helped many people get pregnant, but it’s not the only choice — and sometimes it isn’t the best one. If Clomid failed, caused bad side effects, or you have PCOS, there are solid alternatives to try. Below I’ll walk you through the common options, what to expect, and quick questions to ask your doctor.

Common medical alternatives

Letrozole (Femara) — This is now the go-to first choice for many with PCOS. It’s an oral drug that lowers estrogen signals to the brain so the ovaries release eggs. Typical use is a short course early in the cycle (for example, days 3–7). Studies show higher pregnancy and live birth rates in some PCOS groups compared with Clomid, and fewer mood/vision side effects.

Injectable gonadotropins — These are hormones (FSH/LH) given as shots to stimulate the ovaries directly. They work when oral meds don’t. The main upside is stronger egg growth and a higher chance of ovulation. Downsides: higher cost, need for blood tests and ultrasound monitoring, and a greater risk of multiple pregnancy and OHSS (ovarian hyperstimulation).

Metformin — Not a fertility drug by itself, but useful if insulin resistance or PCOS is present. Metformin can restore more regular cycles and improve response to ovulation drugs. Doctors often use it alongside letrozole or Clomid for people with metabolic issues.

Tamoxifen — An older oral option with a similar idea to Clomid but different side effects. It’s less commonly used now but can help when other meds fail or aren’t tolerated.

Surgery and assisted treatments — Laparoscopic ovarian drilling is a surgical option for some with PCOS who don’t respond to meds. If medications don’t work or if there are other fertility factors (blocked tubes, low sperm count), IVF or IUI become the next steps. IVF bypasses many ovulation issues by fertilizing eggs in the lab.

How to pick the right option and what to expect

Start by checking why Clomid didn’t work — was ovulation achieved? Were side effects the problem? Simple tests (hormones, ultrasound, semen analysis, and an HSG for tubes) shape the next move. If you have PCOS, ask about letrozole first. If tests show normal ovulation but pregnancy still isn’t happening, your provider may suggest IUI or IVF.

Monitoring matters. Oral meds often need mid-cycle ultrasounds or ovulation tracking. Injectables require closer monitoring and specialist care. Know the risks: multiple pregnancy and OHSS with stronger stimulation, mood or vision effects with some oral meds, and higher costs for injectables and IVF.

Quick checklist for your next visit: ask about letrozole vs Clomid for your diagnosis, whether metformin could help, the monitoring plan for injectables, success rates for each option in your clinic, and when to consider referral to a fertility specialist. Keep records of cycles and tests — that makes decisions faster and clearer.

You don’t have to stick with Clomid if it’s not working. There are real alternatives with solid evidence. Talk openly with your doctor, weigh the risks and costs, and choose the path that fits your medical picture and timeline.