Compare Fertomid (Clomiphene) with Alternatives for Fertility Treatment
Oct, 27 2025
What is Fertomid (Clomiphene) and how does it work?
Fertomid is a brand name for clomiphene citrate, a medication used to trigger ovulation in women who don’t ovulate regularly or at all. It’s been used since the 1960s and remains one of the most common first-line treatments for infertility caused by ovulation disorders. Fertomid works by blocking estrogen receptors in the brain. This tricks the body into thinking estrogen levels are low, which signals the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones then stimulate the ovaries to produce and release an egg.
Most women take Fertomid for five days early in their menstrual cycle-usually days 3 to 7 or 5 to 9. Ovulation typically occurs 5 to 10 days after the last pill. Success rates vary, but about 70% of women taking Fertomid will ovulate, and around 30-40% will get pregnant within six cycles.
Why do people look for alternatives to Fertomid?
Even though Fertomid works for many, it doesn’t work for everyone. Some women don’t respond to it at all-this is called clomiphene resistance. Others experience side effects like hot flashes, mood swings, bloating, headaches, or blurred vision. In rare cases, it can cause ovarian hyperstimulation syndrome (OHSS) or increase the chance of twins (about 10%).
Some women also want alternatives because they’ve tried Fertomid for several cycles without success. Others are looking for options that might have fewer side effects, better pregnancy rates, or work faster. There are also situations where Fertomid isn’t recommended-like if you have liver disease, ovarian cysts, or unexplained vaginal bleeding.
Letrozole (Femara): The top alternative
Letrozole (brand name Femara) was originally developed as a breast cancer drug but is now widely used off-label for ovulation induction. Studies, including a landmark 2014 trial published in the New England Journal of Medicine, show letrozole leads to higher live birth rates than clomiphene in women with polycystic ovary syndrome (PCOS).
Unlike Fertomid, letrozole doesn’t interfere with cervical mucus or the uterine lining. This means it may create a more favorable environment for implantation. It’s taken orally for five days, same as Fertomid, but at a lower dose-usually 2.5 mg to 5 mg daily.
Side effects are generally milder: fatigue, dizziness, joint pain, and headaches. The risk of multiples is lower than with Fertomid-around 5-7%. Many fertility specialists now consider letrozole the preferred first-line treatment for women with PCOS.
Injectable gonadotropins: When pills aren’t enough
Gonadotropins are injectable hormones-FSH and sometimes LH-that directly stimulate the ovaries. Common brands include Gonal-F, Follistim, and Menopur. These are stronger than oral medications and are used when Fertomid or letrozole fail.
They work faster and have higher pregnancy rates-up to 20% per cycle in some cases. But they come with trade-offs. You need daily injections, regular blood tests, and ultrasound monitoring to avoid overstimulation. The risk of OHSS and multiple pregnancies is higher, especially triplets or more.
These are usually reserved for women who’ve had three or more failed cycles with oral drugs, or those with more complex fertility issues like diminished ovarian reserve or unexplained infertility. Cost is also a factor: a single cycle can cost $2,000-$5,000 without insurance.
Metformin: For insulin resistance and PCOS
Metformin is a diabetes medication that helps lower insulin levels. In women with PCOS, high insulin can block ovulation. Metformin doesn’t directly trigger ovulation like Fertomid, but it can restore regular cycles by improving insulin sensitivity.
It’s often used alongside Fertomid or letrozole, especially in women with high BMI or elevated insulin levels. Studies show combining metformin with clomiphene improves ovulation and pregnancy rates compared to clomiphene alone.
Side effects include nausea, diarrhea, and stomach upset-usually temporary. It’s not a standalone solution for most, but it’s a valuable add-on for the right patient. Some women start metformin for months before adding an ovulation drug.
Other options: Bromocriptine, Cabergoline, and natural approaches
If high prolactin levels are causing anovulation, medications like bromocriptine or cabergoline can help. These reduce prolactin and restore normal ovulation. They’re not used for general infertility-only when blood tests show elevated prolactin.
Some women explore natural or complementary approaches: acupuncture, vitamin D supplementation, inositol (especially myo-inositol for PCOS), or dietary changes. While these aren’t replacements for medical treatment, small studies suggest inositol may improve ovulation rates in PCOS when taken with clomiphene. Always talk to your doctor before adding supplements.
Choosing the right option: What works best for you?
There’s no single best alternative to Fertomid-it depends on your diagnosis, age, body weight, and medical history.
If you have PCOS, letrozole is often the first choice. If you’ve tried both Fertomid and letrozole without success, gonadotropins are the next step. If insulin resistance is a factor, metformin may be added. For high prolactin, bromocriptine or cabergoline are targeted solutions.
Here’s a quick guide:
- Best for PCOS: Letrozole
- Best if Fertomid failed: Letrozole or gonadotropins
- Best if insulin resistance present: Metformin + ovulation drug
- Best if prolactin high: Bromocriptine or cabergoline
- Best for unexplained infertility after failed oral meds: Gonadotropins
Cost and accessibility: What you need to know
Fertomid is cheap-often under $20 for a cycle in Australia with a prescription. Letrozole is similarly affordable, sometimes even less. Gonadotropins cost 50 to 100 times more. Medicare covers some fertility treatments in Australia, but only under specific conditions. Private insurance rarely covers IVF or injectables unless you meet strict criteria.
Access to specialists matters too. Not all GPs can prescribe gonadotropins-you’ll need a fertility specialist. Letrozole and metformin are easier to get, and many women start with their GP before being referred.
What to do next
If you’re considering alternatives to Fertomid, start with a full fertility workup. Blood tests for hormones (FSH, LH, prolactin, thyroid), an ultrasound to check your ovaries, and a semen analysis for your partner are essential. Don’t assume Fertomid didn’t work because it’s ineffective-it might be that the dose was too low, or you didn’t time intercourse correctly.
Keep a cycle diary: track basal body temperature, cervical mucus, and ovulation predictor kits. This helps your doctor see patterns and adjust treatment faster.
Don’t rush into expensive treatments. Many couples get pregnant with simple changes: timing sex around ovulation, managing stress, losing 5-10% of body weight if overweight, or switching from Fertomid to letrozole.
Is letrozole better than Fertomid for getting pregnant?
Yes, for women with PCOS, letrozole is more effective. A large study showed 27.5% live birth rate with letrozole versus 19.1% with clomiphene. It also has fewer side effects on cervical mucus and the uterine lining, which may improve implantation chances.
Can I take Fertomid and letrozole together?
No, you shouldn’t take them together. Both work on the same hormonal pathway and combining them doesn’t improve results-it only increases side effects. Doctors usually try one, then switch to the other if the first fails.
How long should I try Fertomid before switching?
Most doctors recommend trying 3 to 6 cycles of Fertomid. If you haven’t ovulated by cycle 3, or haven’t conceived by cycle 6, it’s time to reassess. Some women respond in later cycles, but continuing beyond six cycles without success rarely improves outcomes.
Are natural alternatives like inositol effective?
Inositol, especially myo-inositol, has shown promise in small studies for women with PCOS. It can improve insulin sensitivity and restore ovulation in some cases. But it’s not a replacement for medication-it works best as a supplement alongside Fertomid or letrozole, not alone.
Does Fertomid cause birth defects?
No, extensive research shows clomiphene does not increase the risk of birth defects when used correctly. Babies born after Fertomid treatment have the same rate of abnormalities as the general population. The biggest concern is multiple pregnancies, not structural defects.
Final thoughts
Fertomid isn’t the only path to pregnancy. For many women, letrozole offers better results with fewer side effects. For others, metformin or injectables are the right next step. The key is matching the treatment to your specific biology-not just following the most common option.
Don’t give up if Fertomid didn’t work. Your next cycle could be the one that changes everything-with the right drug, the right timing, and the right support.