Fertomid (Clomiphene) vs Alternatives: Complete Comparison Guide

Oct, 17 2025

When a couple’s journey to parenthood stalls, the first question often is: which ovulation‑inducing drug will give the best chance? Fertomid (the brand name for clomiphene citrate) has been the go‑to for decades, but newer options and older tricks are gaining ground. This guide breaks down how Fertomid works, who might benefit, and how it stacks up against the most common alternatives.

What is Fertomid (Clomiphene) and How Does It Work?

Fertomid is a selective estrogen receptor modulator (SERM) marketed primarily for ovulation induction. It binds to estrogen receptors in the hypothalamus, tricking the brain into thinking estrogen levels are low. This triggers a surge of gonadotropin‑releasing hormone (GnRH), which in turn boosts follicle‑stimulating hormone (FSH) and luteinizing hormone (LH) release from the pituitary. The result is accelerated follicular growth and a higher likelihood of ovulation.

The drug comes in 50mg tablets, typically started on day3‑5 of a natural menstrual cycle. Dosage is titrated up to 150mg per day based on response, and treatment is usually limited to six cycles to avoid ovarian hyperstimulation.

Top Alternatives to Fertomid

While Fertomid remains popular, several other agents can be more suitable depending on age, underlying diagnosis, and previous response.

• Letrozole is an aromatase inhibitor that lowers estrogen production, prompting the hypothalamus to increase GnRH output. It’s often preferred for women with polycystic ovary syndrome (PCOS) because it produces a thinner estrogen environment, reducing the risk of multiple pregnancies.
• Gonadotropins (e.g., urinary‑derived menotropin or recombinant FSH) are injectable hormones that directly stimulate the ovaries. They give the highest control over follicle development but require careful monitoring and are the most expensive option.
• Metformin is an insulin‑sensitizing agent used off‑label for ovulation induction in insulin‑resistant PCOS patients. It can be combined with other agents or used alone in milder cases.
• Tamoxifen is another SERM similar to clomiphene but with a slightly different receptor profile. It’s sometimes chosen when clomiphene fails or causes severe side effects.
• Anastrozole is a third‑generation aromatase inhibitor, less commonly used in fertility but occasionally preferred for its short half‑life and low multiple‑pregnancy rate.

Success Rates: How Effective Are the Options?

Clinical data give us a rough picture of how each drug performs in real‑world settings. Success is usually measured by ovulation (≈80‑90% for most agents) and live‑birth rates (≈15‑30% per cycle, varying by age and cause).

Comparison of Fertomid and Common Alternatives

Medication	Mechanism	Typical Dose (UK)	Ovulation Rate	Live‑Birth Rate per Cycle	Common Side Effects	Approx. Cost (per cycle)
Fertomid (Clomiphene)	SERM - blocks estrogen feedback	50‑150mg daily, 5‑10days	≈85%	18‑22%	Hot flashes, mood swings, ovarian cysts	£30‑£50
Letrozole	Aromatase inhibitor - reduces estrogen synthesis	2.5‑5mg daily, 5days	≈80%	20‑24%	Fatigue, mild headache	£40‑£70
Gonadotropins (FSH/hMG)	Direct ovarian stimulation	75‑150 IU daily, 7‑10days	≈95%	25‑30%	Ovarian hyperstimulation, multiple pregnancy	£800‑£1500
Metformin	Improves insulin sensitivity	500‑1500mg daily	≈70%	12‑16% (often as adjunct)	GI upset, metallic taste	£20‑£35
Tamoxifen	SERM - similar to clomiphene	20‑40mg daily, 5‑10days	≈80%	15‑20%	Blurred vision, thrombo‑embolism risk (rare)	£45‑£80

Safety Profile and Side‑Effect Landscape

Every medication carries a risk‑benefit balance. Fertomid’s most cited concerns are hot flashes, mood swings, and a 5‑10% chance of developing functional ovarian cysts. Letrozole’s profile is generally milder, but rare cases of ovarian hyperstimulation have been reported, especially when combined with gonadotropins.

Injectable gonadotropins demand careful ultrasound monitoring because high estradiol levels can precipitate ovarian hyperstimulation syndrome (OHSS). The severity ranges from mild abdominal discomfort to life‑threatening fluid shifts, so physicians usually start with low doses and adjust based on follicular response.

Metformin’s gastrointestinal side effects (nausea, diarrhea) can be mitigated by a gradual titration and taking the dose with meals. Rarely, lactic acidosis is a concern, but it occurs mostly in patients with significant renal impairment.

Tamoxifen carries a small, though notable, increased risk of venous thromboembolism and, in very long‑term use, endometrial changes. Because fertility cycles are short, the absolute risk remains low.

Cost Considerations in the UK Context

Financial pressure is a real part of the decision. Fertomid and clomiphene are generic, making them the most affordable option-often covered by NHS prescriptions for certain indications. Letrozole is slightly pricier but still within a modest personal‑budget range.

Gonadotropins are the costliest tier. Even with NHS support for IVF cycles, the medication portion may require a private contribution. Many clinics offer “shared‑risk” funding schemes where the patient only pays if treatment fails, but the upfront out‑of‑pocket cost can still be steep.

Metformin is cheap, but its efficacy as a stand‑alone ovulation agent is limited to insulin‑resistant PCOS cases. Tamoxifen sits in the middle-more expensive than clomiphene but cheaper than injectable hormones.

Choosing the Right Medication: A Decision Guide

Below is a quick decision tree to help you and your clinician land on the best choice.

1. Are you under 35years old with a diagnosis of PCOS?
• Yes → Start with letrozole (2.5‑5mg) or clomiphene if letrozole unavailable.
• No → Consider fertility cause: if unexplained infertility, clomiphene remains first‑line.
2. Have you failed two cycles of clomiphene?
• Yes → Switch to letrozole or add metformin (if insulin‑resistant).
• No → Continue clomiphene, adjusting dose up to 150mg.
3. Do you have a high risk of multiple pregnancy or OHSS?
• Yes → Prefer letrozole or low‑dose gonadotropins with close monitoring.
• No → Gonadotropins can be considered for higher ovulation rates.
4. Is cost a major constraint?
• Yes → clomiphene (Fertomid) or metformin are the most budget‑friendly.
• No → Gonadotropins or combination protocols can be explored.

Always discuss these steps with a fertility specialist who can tailor treatment to your hormone profile, ultrasound findings, and personal preferences.

Key Takeaways

• Fertomid (clomiphene) remains the cheapest, widely available first‑line agent.
• Letrozole often outperforms clomiphene in PCOS patients and carries a lower multiple‑pregnancy risk.
• Injectable gonadotropins give the highest ovulation and live‑birth rates but are expensive and need intensive monitoring.
• Metformin is a useful adjunct for insulin‑resistant cases; tamoxifen is a backup when clomiphene fails.
• Cost, age, infertility cause, and side‑effect tolerance should drive the final choice.