If Clomid (clomiphene) didn’t work, caused bad side effects, or isn’t a good fit, you still have solid options. Some alternatives are prescription drugs, some are procedures, and some are simple lifestyle steps that improve ovulation. Below are clear choices, who they suit, and what to expect.
Letrozole (an aromatase inhibitor). For many people with PCOS, letrozole is now the first choice. Large clinical trials found higher pregnancy and live birth rates with letrozole than with clomiphene in women with PCOS. It usually causes fewer hot flashes and less thinning of the uterine lining. You’ll need a prescription and follow-up ultrasounds to time ovulation.
Gonadotropin injections (FSH/LH). These are injectable hormones that directly stimulate the ovaries. They’re powerful and work when oral meds fail, but require close monitoring by a fertility clinic because they increase the risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS). Expect blood tests and frequent scans.
Metformin (for insulin resistance). If insulin resistance or type 2 diabetes is part of your story—common in PCOS—metformin can help restore regular cycles and improve response to ovulation drugs. It’s often used together with other treatments rather than as a lone fertility drug.
Tamoxifen. Less common than letrozole, tamoxifen is another pill that can trigger ovulation. It may be considered when other options aren’t suitable, but it’s used less often than the drugs above.
IUI and IVF. If medication alone doesn’t work, intrauterine insemination (IUI) or in vitro fertilization (IVF) are the next steps. IUI pairs ovulation drugs with timed insemination. IVF bypasses ovulation timing by fertilizing eggs in the lab. Both need clinic visits and clinical guidance on risks and costs.
Surgical option. Laparoscopic ovarian drilling is a surgical choice for some people with PCOS who don’t respond to meds. It can restore ovulation for a time but comes with surgical risks, so it’s less common now that drugs like letrozole work well.
Lifestyle first. If you’re overweight, losing even 5–10% of body weight often improves ovulation and drug response. Work on sleep, reduce high-sugar and processed foods, and aim for regular moderate exercise. These changes don’t replace medical treatment but often make medications more effective.
Supplements. Some people use inositol or vitamin D when managing PCOS. Evidence is mixed but promising for inositol improving insulin sensitivity and ovulation in certain cases. Always check with your doctor before starting supplements.
How to pick the right path: talk to a fertility specialist or your OB-GYN. They’ll consider your diagnosis (PCOS, unexplained infertility, low ovarian reserve), age, prior treatments, and how quickly you want to try. Monitoring, safety, cost, and time to pregnancy all affect the best choice for you.
If you have questions about a specific alternative or want a quick comparison between letrozole and gonadotropins for your situation, ask your provider or bring specific concerns to your next appointment.
