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
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.
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Hope you found my response to your query informative and helpful.
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With good wishes,