Did Clomid (clomiphene) fail to help you ovulate or cause frustrating side effects? You’re not stuck. Several proven alternatives can improve chances of pregnancy depending on why you’re struggling — PCOS, unexplained infertility, or male-factor issues.
Letrozole (Femara) — an oral aromatase inhibitor — is now a first-line option for many people with PCOS. A 2014 randomized trial found letrozole produced higher live-birth rates than clomiphene in women with PCOS. Letrozole usually stimulates fewer hot flashes and mood swings, and many clinics prefer it for PCOS-related anovulation.
Injectable gonadotropins (FSH/LH) — these are hormones given by injection to stimulate the ovaries directly. They work when oral meds fail or when timed intrauterine insemination (IUI) or IVF is planned. Expect closer monitoring (ultrasounds and bloodwork) and higher costs, plus a greater risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).
Metformin — not an ovulation drug by itself, but useful when insulin resistance is present (common in PCOS). Adding metformin can improve cycle regularity and sometimes boosts success with clomiphene or letrozole. Your doctor will check blood sugar and weight-related factors before recommending it.
Surgery — laparoscopic ovarian drilling is an option for select patients with PCOS who don’t respond to medications. It’s less common now but can trigger ovulation when other treatments fail.
Start by figuring out the cause. If tests show PCOS, letrozole is often the smartest next step. If you have normal ovulation or male-factor infertility, your provider may recommend IUI with injectables or move straight to IVF for faster results.
Ask about monitoring: injectables need frequent ultrasounds and blood tests to lower OHSS and twin risks. Oral meds like letrozole usually need less intense monitoring. Also compare costs — injectables and IVF are more expensive than pills.
Side effects differ: letrozole tends to cause fewer estrogen-blocking symptoms than clomiphene. Injectables can cause ovarian swelling, mood changes, and a higher chance of twins. Always tell your doctor about past mood issues, liver problems, or blood clots — these affect safe choices.
Timing matters. If you’re under 35, many doctors try 3–6 cycles of medication before moving on. If you’re over 35 or have known fertility factors (blocked tubes, severe male infertility), consult a fertility specialist sooner.
Want next steps? Ask your clinician for a clear plan: which drug, how many cycles, what monitoring you’ll get, and when to escalate to IUI or IVF. That keeps the process practical and focused on what will actually help you get pregnant.
