Alternative to Clomid: What Actually Works for Ovulation

Trying to get pregnant and Clomid didn’t work — now what? You’re not alone. There are solid alternatives that doctors use depending on why ovulation isn’t happening. Below I’ll walk through the main options, what to expect, and when to see a fertility specialist.

Letrozole (Femara) — a common first switch

Letrozole is an aromatase inhibitor often used for ovulation induction, especially in women with PCOS. It usually causes fewer hot flashes and can lead to better ovulation and live birth rates than Clomid for many people. A major trial showed letrozole produced higher live birth rates than clomiphene in women with PCOS, so many doctors now try it first when Clomid fails. Side effects are usually mild but talk to your doctor about timing and dose — it’s often given early in the cycle for 5 days.

Injectable gonadotropins — stronger but higher risk

If oral pills fail, injectable hormones (FSH and sometimes LH) are the next step. These directly stimulate the ovaries and tend to work when pills don’t. The trade-offs: injections are more expensive, need frequent blood tests and ultrasounds, and carry higher risk of ovarian hyperstimulation syndrome (OHSS) and multiples. Those risks are manageable with good monitoring at a clinic.

Other medical options include:

• Metformin — not a direct fertility drug, but helpful for insulin resistance in PCOS. It can restore ovulation in some people and is often combined with letrozole.
• Aromatase inhibitors vs SERMs — letrozole (an aromatase inhibitor) replaces clomiphene (a SERM) in many cases because it can create a better uterine lining and hormone profile.
• Intrauterine insemination (IUI) — often used with pills or injectables to improve chances by placing sperm closer to the egg.
• IVF — the most effective option if other treatments fail or if there are additional issues like blocked tubes or low sperm count. It’s more invasive and costly but also gives you the most control.

Don’t forget the non-drug stuff. Losing 5–10% of body weight if you’re overweight can restart regular cycles. Quit smoking, limit alcohol, and aim for a balanced diet and steady exercise — these small changes can boost response to medication and improve egg quality.

When should you see a specialist? If you’re under 35 and haven’t conceived after 6–12 months of trying, or if you’re over 35 and haven’t conceived after 6 months, see a reproductive endocrinologist. Also see a specialist sooner if you have known issues like blocked tubes, severe endometriosis, or low sperm count.

Bottom line: Letrozole, injectables, IUI, and IVF are the main alternatives to Clomid. Each has pros and cons depending on your diagnosis, age, and budget. Talk openly with your doctor about risks, monitoring needs, and realistic timelines — that will help you pick the best next step.