Clomid alternatives: what to try if clomiphene isn’t working

If Clomid (clomiphene) didn’t cause ovulation or led to bad side effects, you’ve got options. Some alternatives work better for certain causes of infertility, like PCOS or low ovarian reserve. Here’s a plain‑spoken guide to the most used options, what they do, and quick pointers so you can talk to your doctor with confidence.

Top medical alternatives and how they differ

Letrozole (Femara) — an aromatase inhibitor used off‑label for ovulation induction. In people with PCOS, letrozole often produces higher pregnancy and live‑birth rates than Clomid in clinical trials. It usually has fewer mood and hot‑flash side effects and fewer thin‑endometrium problems that can hurt implantation. Typical starting doses are low (e.g., 2.5 mg), but follow your doctor’s plan.

Injectable gonadotropins — injectable FSH or combined FSH/LH stimulate the ovaries directly. These give the most control over follicle growth and work when oral meds fail, but they need frequent blood tests and ultrasound. The tradeoffs: higher cost, more clinic visits, and a bigger risk of multiple pregnancy and OHSS (ovarian hyperstimulation).

Tamoxifen — an older option sometimes used when Clomid causes bad estrogen‑related side effects. It can induce ovulation in people who don’t respond to Clomid and may be a good step before moving to injections.

Enclomiphene/Enclomisign — a newer compound related to clomiphene; it’s discussed more for male fertility (boosting testosterone while preserving sperm production) but research is evolving. If you’re exploring male factor causes, ask about enclomiphene as an option with a specialist.

Surgery and ART — laparoscopic ovarian drilling (for selected PCOS cases) and IVF are options when medications fail or when other issues (tubal disease, severe male factor) are present. IVF bypasses many ovulation problems but is the most intensive and costly route.

Other practical steps and things to ask your doctor

Address underlying issues first. If you have PCOS, losing 5–10% body weight can restore regular ovulation. If you’re insulin‑resistant, adding metformin may help in some cases—ask about how it might fit your plan. Track cycles with ovulation kits and ultrasound when starting a new treatment so you know what’s happening.

When to switch? A common rule is to re‑assess after 3 failed ovulation cycles on one treatment, sooner if you’re over 35 or have other fertility factors. Ask about monitoring frequency, costs, pregnancy rates, and side effects for each option. If you want fewer clinic visits, oral agents like letrozole or tamoxifen may appeal; if you need stronger stimulation, be ready for injections and closer monitoring.

Bottom line: there’s no one‑size‑fits‑all. Match the alternative to your diagnosis, tolerance for side effects, and budget. Bring this list to your doctor or a fertility specialist and make a clear plan together.