Letrozole didn't work, what options do I have left?

[Omgdnswv]

Just finished my prescription of letrozole without any success, tomorrow I have a follow up phone call. I think I remember before I started letrozole they said that if I do ovulate through it but don't conceive then the next step would be IVF, but I looked up the restrictions in my area and I don't qualify for another year yet.

I'm trying to make a list of things to ask the doctor if theyre worth trying in case they just want to dump me and say "see ya in a year", so far I have:
-as clomid and letrozole work by different means, could it be worth trying clomid now?
-gonadotrophins?
-check if I've been tested for insulin resistance (I have PCOS but have no weight problems)
-metformin?
-ovarian drilling?
-repeat sperm test as it's been a year and it was only acceptable, not great, and my partner isn't all that young anymore
-is there any way around the 3 year wait? (I know absolute infertility, like 0 sperm or both tubes blocked don't need to wait 3 years, but I don't think we would qualify for anything quite as extreme)

TTC history:
I've had a Hycosy before I was prescribed letrozole. Letrozole: 2.5mg didn't work, 5mg for 6 months did make me ovulate, on the 7th month I had pills spare and took the extra making it 7.5mg on 4 of the 5 days cause I got desperate but that didn't make a difference either.
Tried agnus castus before I was diagnosed, inositol after diagnosis (did shift my cycles from around 75 days down to 40-60 days), lots of vitamins and supplements for both me and partner, obviously folic acid, and the last half year I've massively reduced my sugar intake, increased healthy eating, done more walking, drunk more water, taken a big step away from work stresses, reduced plastic and chemical exposure as per "it starts with the egg".

Is there anything else that can be tried before resorting to IVF? Treatments or tests? Anything I can bring up at the phone call tomorrow?

@Omgdnswv were you scanned during your medicated cycles? I found that letrozole was thinning my uterine lining, so even the cycles I ovulated there was a little chance for implantation to happen. If that’s the case gonadotropins should do the trick.
Repeating SA is always a good idea.
I don’t think clomid and/or metformin would make much of a difference as you already ovulate on letrozole.

@WafflesNCream I asked for scans on the last cycle but they said they can't do that, only thing they could offer were blood tests to confirm ovulation

@Omgdnswv Ok, maybe gonadotropins with IUI could be an option then? That’s what my consultant is moving me to since letrozole is not working for me. Not sure what the waiting times are, but hopefully not as bad as IVF.

@WafflesNCream I thought IUI was like an alternative to IVF with the same requirements to get it under the NHS? Definitely a question to raise tomorrow, thank you

@Omgdnswv ICSI is a form of IVF, IUI is less complicated. I’ve heard that some doctors don’t see the point of IUI as the success rates aren’t very high, but it’s worth asking.