Hi,

Welcome to HCM,

It is possible that your wife is suffering with PCOD.

Patients suffering with Poly cystic ovarian disease have multiple small cysts in their ovaries.

Ovaries become enlarged and produce excessive amount of estrogen and androgen hormones.

Absence of ovulation causes infertility.

Many patients with PCOD also have insulin resistance and have raised level of insulin.

These patients may not respond to clomiphen, thus treated with anti diabetic drugs like metformin and troglitazone.
Clomiphen is used to stimulate ovulation. Low doses of dexamethasone can be given simultaneously to suppress androgen production from adrenal gland.

If clomiphen doesn't work, a new anti-estrogen called Letrozole can be used.

Clomifen resistant women suffering with PCOD, may need HMG(gonadotrophis) to induce ovulation.

Difficult patients may require a combination of GnRH analog and HMG to induce ovulation successfully.

Metformin can improve your fertility by reversing endocrine abnormality and improving your ovulatory response.

You should take her to a experienced Gynecologist for examination, investigations and treatment.

Thanks for trusting Healthcaremagic and posting your query.

Hope you found my response to your query informative and helpful.

If you have further concerns in this regard, you can submit those with Healthcaremagic as well.

With good wishes,