Question:

We have been trying to get pregnant for almost three years now, and I tried letrozole last year. Is it possible to try clomiphene?

Answered by Dr. Karen Carlson:

In short, the answer is yes.

Both clomiphene citrate (Clomid) and letrazole (Femara) are used to help women with ovulatory disorders to ovulate and to achieve pregnancy. Clomiphene has been used for many years and has been very commonly prescribed in the past. More recently, over the past 20 years, most gynecologists have turned to letrazole to treat ovulatory disorders in women who want to be pregnant. Letrazole was originally FDA approved for the treatment of breast cancer, but it has been used off-label for years to help induce ovulation.

Both clomiphene and letrazole increase LH and FSH levels to help with egg development and ovulation, which increases the chance of achieving pregnancy in women with ovulation problems. More recently, letrazole has proven to be more effective and to have fewer side effects in many studies. Because of this, it is the most commonly used medication to treat ovulatory disorders in women who want to conceive. 

If the letrazole is not working for you, you may want to try adding a medication like metformin, that decreases insulin resistance and works together with letrazole. However, a trial of clomiphene could be an option as well. 

Talk to your provider about the next steps and the varying options for moving forward in your therapy.