Clomid Alternatives: What Works for Ovulation

Clomid (clomiphene) helped a lot of people, but it’s not the only option — and for some, it isn’t the best. If you’ve tried Clomid without success, have PCOS, or worry about side effects, there are clear alternatives worth asking your doctor about. Below I’ll walk you through common choices, why clinicians pick them, and what to expect.

Prescription drug options

Letrozole (Femara): Many fertility clinics now prefer letrozole for women with PCOS. It’s an aromatase inhibitor usually taken 2.5–5 mg daily for five days early in the cycle. Compared with Clomid, letrozole often produces better ovarian response and may lead to higher pregnancy and live-birth rates in PCOS. Side effects are generally milder — fatigue and joint pain are the common ones.

Gonadotropins (injectables): If oral meds fail, injectable FSH or a combination of FSH/LH stimulates the ovaries directly. These are more powerful and give tighter control over follicle growth, which helps time insemination or egg retrieval. Downsides: higher cost, more clinic visits, and a real risk of ovarian hyperstimulation syndrome (OHSS). Most clinics monitor with bloodwork and ultrasound to reduce risks.

Tamoxifen and metformin: Tamoxifen acts somewhat like Clomid and can help ovulation in select cases. Metformin isn’t an ovulation drug by itself, but when insulin resistance is a factor (common in PCOS), combining metformin with ovulation agents can improve results and reduce miscarriage risk for some patients.

Procedures, lifestyle, and other choices

Intrauterine insemination (IUI): IUI is often paired with oral meds or injectables to boost success without moving straight to IVF. It’s simple: sperm is placed directly into the uterus around ovulation. Costs and invasiveness are moderate compared to IVF.

Laparoscopic ovarian drilling: A surgical option used rarely now, ovarian drilling can restore ovulation in some women with PCOS who don’t respond to meds. It’s usually a one-time procedure but comes with standard surgical risks.

Lifestyle changes: Small things help. Losing 5–10% of body weight if overweight often restores regular cycles and boosts medication success. Stop smoking, limit alcohol, and aim for steady blood sugar through balanced meals — these tips improve the odds and overall health.

When to pick what: If you have PCOS, ask about letting letrozole take the lead. If oral drugs fail, injectable gonadotropins and assisted techniques (IUI/IVF) come next. If insulin resistance shows up, add metformin. Your age, diagnosis, and budget shape the path.

If you’re weighing options, bring this list to your fertility specialist and ask about success rates, side effects, monitoring plans, and costs. Fertility care is personal — the right alternative to Clomid depends on your body and goals.