Clomid (clomiphene) has been a go-to drug for ovulation problems, but it isn’t the only choice. If Clomid didn’t work for you, caused side effects, or your doctor prefers another route, there are clear alternatives that often work better for certain people. Below I cover the main medical options, plus non-drug steps and what to expect during treatment.
Letrozole (Femara) is the top alternative, especially for people with PCOS. Studies show letrozole often produces higher live birth rates than Clomid in PCOS patients. It boosts ovulation by lowering estrogen briefly, which tells the brain to release more follicle-stimulating hormones. Typical use is low-dose early in the cycle for five days, but your doctor will set the right dose.
Gonadotropin injections are another option. These are hormone shots (FSH or combined FSH/LH) that directly stimulate the ovaries. They’re powerful and work when pills don’t, but they need close monitoring with blood tests and ultrasounds to avoid overstimulation and reduce the risk of multiple pregnancies.
Metformin is often used for people with insulin resistance or PCOS. It won’t trigger ovulation on its own for everyone, but it can improve cycles and make ovulation drugs work better when insulin resistance is a factor.
Lifestyle changes matter. Losing even 5–10% of body weight can restore regular cycles in people with PCOS. Quit smoking, reduce excess alcohol, and aim for regular sleep and moderate exercise. These steps improve hormone balance and increase the chance that medications will work.
Supplements like myo-inositol and vitamin D show promise for improving ovulation in some women with PCOS. They’re not magic, but they’re safe for many and worth discussing with your provider.
If medications fail or if there are other fertility issues, treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF) are next. IVF bypasses ovulation issues by creating embryos in the lab. IUI can be combined with timed ovulation drugs for a step-up approach.
What about risks? Any fertility treatment can raise the chance of twins or more, especially with gonadotropins. Ovarian hyperstimulation syndrome (OHSS) is a serious but manageable risk with injectable hormones. That’s why clinics monitor follicles and hormone levels closely.
Bottom line: letrozole is often the first swap for Clomid, gonadotropins are the next step if pills fail, and lifestyle plus supplemental support can make treatments work better. Talk to your fertility specialist about your diagnosis, fertility goals, and tolerance for monitoring and side effects. A personalized plan gives the best chance of success.
