Brief Answer:
pcos

Detailed Answer:
Hi XXXXXXX
Serum insulin is usually done if there is suspicion of a hormonal condition called polycystic ovaries . Patient may have irregular cycles in which case pregnancy may be may be difficult . You haven't mentioned any history regarding your wife's cycles . But if she has irregular cycles then there is suspicion possibility of pcos . Pcos causes a hormonal imbalance in the bodywhich in turn , may cause difficulty in concption . However with medication chances of pregnancy nowadays is much better .

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Brief Answer:
undergo these tests

Detailed Answer:

hello, since you have a child already, some tests need to be done first. The first step to be taken is to regularise your cycles. With normal bleeding. Check your hormone levels for LH, FSH, tsh and Prolactin. Your serum insulin is already high. Start metformin tablets daily. If you are over weight then weight loss is important. High insulin levels can cause weight gain. An ultrasound of the pelvis needs to be done to determine features of pcos. If the hormone levels are all normal, then the next step would be to do an hsg. Its basically an xray to find out if there is any tubal blockage. If its clear then folliculometry will determine whether you are ovulating. If not, then ovulation induction drugs will ne required. This is a long drawn out process. You should see a infertility specialist who cam guide you. It will be prudent to get your husbands semen analysis done also. Its a long process and has to be taken step by step. Once all the reports are done, you will get a better idea how to proceed.

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