Clomiphene Comparison: Alternatives, Effects, and What Works Best

When it comes to treating infertility, Clomiphene, a selective estrogen receptor modulator used to trigger ovulation in women with irregular cycles. Also known as Clomid, it's one of the most common first-line treatments for women trying to conceive. But it’s not the only option. Many people don’t realize that Letrozole, an aromatase inhibitor originally developed for breast cancer is now often preferred over Clomiphene in clinical guidelines, especially for women with PCOS. Studies show Letrozole leads to higher live birth rates and lower multiple pregnancy risks compared to Clomiphene. Then there’s gonadotropins, injectable hormones like FSH and LH that directly stimulate the ovaries—more powerful, more expensive, and used when pills fail.

Clomiphene works by blocking estrogen receptors in the brain, tricking it into thinking estrogen levels are low. That triggers the pituitary gland to pump out more FSH and LH, which then push the ovaries to produce eggs. But it doesn’t work for everyone. Some women don’t ovulate on it at all. Others get side effects like hot flashes, mood swings, or blurred vision. And while Clomiphene is often cheaper and easier to take than injections, its success rate drops after three to six cycles. That’s why many doctors now start with Letrozole, especially for women with insulin resistance or PCOS, because it doesn’t interfere with cervical mucus or the uterine lining the way Clomiphene sometimes does.

What you choose depends on your body, your diagnosis, and your goals. If you’ve been trying for a while without success, knowing how Clomiphene stacks up against other options helps you ask better questions. You might be surprised to learn that some clinics now use Letrozole as the default, not Clomiphene. Or that combining Clomiphene with metformin can improve results for women with insulin issues. And if you’ve had a bad reaction to one pill, there’s almost always another path. Below, you’ll find real comparisons between Clomiphene and other fertility treatments—what works, what doesn’t, and what side effects you’re actually likely to face.