What if Clomid Still Does Not Work?

Sometimes, ultrasound will show the follicles growing in response to Clomid, but the midcycle LH surge isn’t strong enough to bring on ovulation. In this case, your doctor may prescribe Clomid along with an injection of hCG, like the drug Ovidrel, to trigger ovulation and boost the midcycle LH surge.

If after trying these options, you are still not ovulating on Clomid, your doctor may suggest trying different ovarian stimulating medications. Hopeful studies are emerging about the medication Letrozole, also known as Femara. Studies have shown that Letrozole may induce ovulation in some women with PCOS who do not respond to Clomid, as well as some women with unexplained infertility and Clomid resistance.

In one study, women with Clomid resistance and PCOS were more likely to ovulate when taking the medication Letrozole (79.3% ovulated), than when taking Clomid in combination with two, low dose injections of FSH therapy (56.59% ovulated). Pregnancy rates were also improved, with 23% of the women taking Letrozole achieving pregnancy, and 14% achieving pregnancy with the Clomid and two-injections of low-dose FSH combination.

Letrozole is not, however, sold as a fertility drug, and there is some controversy over the safety of its use. Letrozole can cause birth defects if taken during pregnancy. Many argue that the medication is safe and say that the drug should be out of your system by the time pregnancy occurs, though more research needs to be done.

Other options for treating Clomid resistance include low-dose gonadotropin therapy, with or without IUI treatment. This includes drugs like Gonal-F, Follistim, and Ovidrel, in other words recumbent FSH and LH fertility drugs. These drugs are more expensive and come with more side effects than Clomid, but they may induce ovulation when Clomid fails.