An infertility specialist told me, after many tests, that I am ovulating but the follicle was not large enough. He said that could be the reason I'm not getting pregnant. I don't want to go on fertility drugs. Is there anything more natural I can do to address this? Should I get a second opinion?

H.B.

Each month, the egg develops within the ovary in a fluid-filled sac called a follicle. By the time of ovulation, that sac has usually grown to two centimeters (about three-fourths of an inch) or more. When drugs are used to induce ovulation, we often find that normal mature eggs may be present at a smaller size. The size is important, as the follicle produces hormones that nurture a developing egg. Its size suggests whether the follicle is likely producing the appropriate amount of hormone and indicates whether there will be a normal environment for sustaining a pregnancy.

Follicles may fail to start their growth or grow to a certain point and stop growing. This disturbance in the normal ovulatory pattern can certainly be a cause of fertility problems. We are not really sure why some women fail to develop sufficiently large follicles. Certainly if you have a known problem that interferes with ovulation such as polycystic ovary syndrome, thyroid disorder, pituitary problems, obesity, excess exercise, dieting or stress, this could interfere with normal growth of the ovarian follicle. If a specific problem is found during a diagnostic evaluation, then treatment aimed at correcting the problem may be successful. Modification of diet, weight, stress and exercise may restore more normal ovulation.