Clomid alternatives: what to try when clomiphene doesn’t work

Trying to get pregnant but Clomid (clomiphene) didn’t do the job? That’s frustrating, but you have options. Some people don’t respond, others can't tolerate side effects like hot flashes, mood swings, or a thin uterine lining. Below are clear, practical alternatives—when they’re used, what to expect, and simple next steps.

Top medical alternatives

Letrozole (Femara) — This aromatase inhibitor is now a go-to alternative, especially for people with PCOS. A major randomized trial found letrozole led to higher live-birth rates than clomiphene in women with PCOS. Letrozole often produces better endometrial thickness and fewer mood or visual side effects than Clomid.

Gonadotropins — These are injectable FSH or FSH/LH mixes used when oral drugs fail. They work well but need close monitoring with ultrasound and blood tests because they raise the risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS). Expect more cost and more clinic visits.

Tamoxifen — An older alternative sometimes used for ovulation induction. It can help in certain cases and may be chosen if letrozole or clomiphene aren’t suitable, though it’s less commonly recommended than letrozole today.

Metformin (as an add-on) — For people with insulin resistance or PCOS, metformin can improve ovulation when combined with letrozole or clomiphene. It’s not usually used alone for fertility but can boost success in specific cases.

IUI and IVF — If medication alone doesn’t work, timed intrauterine insemination (IUI) combined with ovulation induction is a next step. IVF is the most reliable option for many causes of infertility and bypasses ovulation problems entirely, but it’s costlier and more involved.

How to pick the right option

Start with a clear diagnosis. Is it PCOS, anovulation, low ovarian reserve, or something else? Your doctor will check hormone levels, ultrasound, and partner testing when needed. If PCOS is the issue, many clinics now try letrozole first. If oral meds fail after a few cycles (often 3–6), talk about gonadotropins or IUI.

Ask about monitoring: injectables need more frequent scans and bloodwork to avoid OHSS and multiple pregnancy. Discuss side effects, cost, and the clinic’s experience. If you have other health issues—thyroid disease, high BMI, or insulin resistance—treating those can improve results.

Bottom line: don’t assume Clomid is your only path. Letrozole is a strong, evidence-backed alternative for many. If oral meds don’t work, gonadotropins, IUI, or IVF are reasonable next steps—each with trade-offs in cost, monitoring, and success rates. Talk with your fertility provider to match an option to your diagnosis, timeline, and budget.