Clomiphene alternative: what to try if clomiphene didn’t work

If clomiphene didn’t give you the results you wanted, you’ve got options. Some people don’t respond, others get side effects, and some need a different path because of specific conditions like PCOS. Below I’ll walk through common alternatives, what they do, and practical points to discuss with your doctor.

Common medication alternatives

Letrozole (aromatase inhibitor) — Many clinics now prefer letrozole, especially for people with PCOS. It usually improves the uterine lining and can lead to higher pregnancy rates than clomiphene for some groups. Typical use is a short course early in the cycle (doctors often prescribe 2.5–5 mg daily for five days), but your doctor will pick the right dose and timing.

Tamoxifen — Works a bit like clomiphene but may be better for people who had poor lining with clomiphene. It’s less commonly used than letrozole but can help when clomiphene causes thin endometrium.

Gonadotropins (injectable FSH/LH) — These are stronger drugs that directly stimulate the ovaries. They work well when oral meds fail but require bloodwork and ultrasound monitoring because the risk of ovarian hyperstimulation and multiple follicles is higher. Good option if you’re under close clinic care.

Metformin (for PCOS) — Not a direct ovulation drug, but if insulin resistance is part of your problem, metformin can restore cycles when paired with other treatments. It’s often combined with letrozole or used before trying other meds.

Non-drug and procedural options

Intrauterine insemination (IUI) — Combining ovulation drugs with IUI can raise your chances if timed correctly. It’s a low-complexity step up from timed intercourse.

IVF — If oral meds and injectables don’t work, IVF is the next step for many. It’s more invasive and costly, but it offers higher control and success rates in many cases.

Lifestyle fixes — Small changes can matter. If you have PCOS or are overweight, losing 5–10% of body weight can restore ovulation. Quit smoking, limit alcohol, and aim for steady exercise. These steps improve treatment response and overall fertility.

Each option has trade-offs: letrozole often has fewer lining problems; gonadotropins are powerful but need monitoring; IVF raises success but costs more. Don’t change or start meds without talking to your doctor. Ask about monitoring plans, side effects, and realistic timelines—most treatments take a few cycles to show results.

If you want, tell me a bit about your diagnosis (PCOS, unexplained infertility, ovulation tests) and I can help outline what people often try next and which questions to bring to your clinic.