The journey isn’t just physical; it’s painfully emotional, deeply cultural, and still not talked about enough
Fertility struggles can be a lonely and emotional journey, especially in a society where talking about it still carries stigma. But support, both medical and emotional, is growing. At the forefront of this shift is Dr. Salleha Khalid, a fertility and gynaecology expert at Sophea Fertility.
“This clinic is a dedicated fertility centre where we do everything in one place—including IVF and genetic testing,” she shares. “It’s designed to be woman-friendly and husband-friendly, because we understand how sensitive and emotional the entire process can be.”
Known for her warm, relatable presence online, Dr. Salleha also uses her platforms on Instagram and TikTok to break down taboos and offer guidance to couples navigating fertility issues.
1Twenty80: Can you share what are the most common fertility issues in Malaysia?
Dr. Salleha Khalid: The most common for females is polycystic ovary syndrome (PCOS) as well as endometriosis. For males, it’s more towards male subfertility, where there’s a low sperm count, the sperm isn’t moving fast enough, or the shape of the sperm isn’t normal. About 50% of couples’ fertility issues come from the male (yes, almost that high). But often, the issues overlap. So there may be a male factor as well as a female factor. If a couple comes in, the cause may be from just one side (either male or female) but in a significant number of cases, both the husband and wife have fertility issues.
1Twenty80: Are there cultural differences between Malaysia and other countries in how people talk about fertility challenges?
Dr. Salleha: Yes, I’ve worked in the UK before, in a fertility clinic, and over there, they’re quite open. They see it as a medical issue, like hypertension or diabetes, something that needs help. But in Malaysia, there’s still a bit of stigma around it. From what I’ve observed, there’s this impression that fertility issues are like a curse, or that it’s the result of something they’ve done—maybe from a previous mistake or old sins. So there’s a lot of overthinking involved.
Because of that, many will seek other forms of treatment first, like going to traditional healers, to try and solve the issue. And only after all that, then they come to see a medical doctor. It’s because they don’t always see it as a medical issue, especially among Malaysian Malays. I’m not too sure about the Chinese or Indian communities, they may have a similar background, but the majority of patients we see here are Malay.
Sometimes we’ll ask, “You’ve been married for 5 or 10 years, and this is your first time seeing a doctor?” And they’ll say, “Oh, we tried traditional medicine first, doctor.” But I do feel these cases are getting less and less now—thanks to social media. I think we’re able to reach more people that way. That’s why many doctors are now on social media.. to help spread the message.
The younger generation seems to be more sensible in a sense that they don’t usually go for all that. They’ll come straight to see a doctor. So there’s a bit of a generational gap. Those in their late 30s will usually try the traditional methods first. But the younger ones, around 28-30, they’ll come to us directly.
As far as I can see, our people still like to believe things like, “Oh, this fruit will heal your fertility,” or “This will improve your egg numbers.” So they’ll try all that first, and only then come to the doctor.
1Twenty80: What is your personal view on that?
Dr. Salleha: Well, you can try.. but as long as you know your limits. Don’t take too long. Ideally, come and see a doctor early on, just to check. Once you get your foundation, say your uterus is alright, your egg count is okay, then you can take your time to try naturally, improve your lifestyle, and so on. But if something is detected early, then we can do something about it much sooner.
1Twenty80: So how early should couples consider seeking help if they’re struggling to conceive?
Dr. Salleha: A lot of people ask the same thing: “We want to get pregnant, but we don’t know when to start seeking help.”
Here’s a simple guide:
After one year of trying
Couples should seek help if:
- The woman is under 35 years old
- They’ve been having regular, unprotected intercourse for one year but still haven’t conceived
After six months of trying
Couples should consider getting checked earlier if:
- The woman is 35 years old or above
- Either partner has a known issue that could affect fertility, such as:
- A history of ovarian cysts
- A previous injury (for example, a sports injury involving the male’s private parts)
- The woman has irregular periods, or missing periods for several months, which could indicate an underlying issue
1Twenty80: We know Malaysians generally stigmatise anything related to fertility and sexual health, so do you think this affects couples emotionally or delays them from seeking help?
Dr. Salleha: Definitely. If we ask a couple how many times they’ve planned to come and see a fertility doctor—it’s usually many times. In fact, we have a lot of couples who book appointments regularly but cancel the day before. They’ll cancel or they just won’t turn up because they don’t have the courage. They’re afraid that… it’s them.
We even have a few regulars who check in, but then last minute they don’t answer the phone or don’t show up. We understand that it might be because of anxiety, because when both partners come, they get their sort of ‘verdict’ or diagnosis on the spot. And that moment is very, very nerve-wracking. They want to know: is it me, or is it him? Is it me, or is it her?
Some even say, “I’m sorry, doctor, I don’t have the strength yet.” So we do understand. And for those who do come and proceed with the tests, for example the sperm sample, it takes about two hours for the result to be ready. During that time, the man will be very, very anxious. Sometimes they’ll sit in the clinic and not even want to look at us. They just want to see the result. We’ll reassure them gently, and only then do they start to relax. Once the sperm results are out, the focus shifts to the woman, who’s often just as nervous. Many say they’re scared before the scan, so we try to comfort them, reminding them they’re not alone: their husband is there to support them, and we’ll go through it step by step, together.
If we do find anything abnormal, of course they’ll be upset. Especially for the men. Many women could feel it, like when their periods are so painful, or they feel more bloated than before. Things feel different. But for men, there would be no symptoms. They produce sperm, they have semen volume, so they think everything is okay. But they don’t know the count until we look under the microscope. So when we have to break the news that there’s no sperm in it, or very, very few sperm—it’s hard for them to accept. They’ll say, “But I’m healthy. I don’t smoke, I don’t vape, I exercise regularly, I don’t take drugs or alcohol. So why?” Sometimes we also can’t explain thoroughly why. We can do assessments up to a certain extent. We can test male hormones, we can do an ultrasound, or even look at the genetic makeup. But for the majority of them, everything seems normal. We still can’t explain clearly why the sperm count is low.
So we’ll invite them to come again in one or two months for a second sperm test, to see: is it truly the same? There are treatments that can help. That’s why we encourage follow-up testing. To see if the results are the same, if they’re getting worse, or if there’s improvement with certain lifestyle changes.
1Twenty80: Are men equally open to addressing fertility concerns, or is it usually seen as a women’s issue?
Dr. Salleha: Lately, we’re seeing more and more husbands accompany their wives, because we do encourage them to go through the process together, especially since this is a one-stop centre. In the past, from 10 couples, maybe only 1 or 2 husbands would come along. Usually, they’d ask their wives to get checked first. Once the wife was ‘settled’, then they’d come. Or sometimes it’s the other way around—the husband wants to get checked first to make sure he’s ‘alright’, and then he’ll bring his wife.
I suppose they still might not be ready to face the results at the same time. Unless the husband already knows his sperm is okay, only then he feels confident bringing his wife to get checked. But recently, men have become more open, especially because of what we see in the news and media. Western media, in particular, has been highlighting the issue and encouraging men to get tested, because sperm count has dropped by more than 50%.
If you compare sperm counts from the 1970s to now, the average has declined significantly.* It likely has something to do with our lifestyle, maybe due to microplastics, the food we eat, and high estrogen exposure… I’m not sure. But there’s clearly a link to modern lifestyle, because the numbers have dropped drastically. Not to the point of being extremely low yet, but if nothing is done, the trend could continue.
*That particular study was conducted among European men, comparing the average sperm count from the 1970s to now.
1Twenty80: How critical is the impact of smoking on fertility, especially since it’s often overlooked?
Dr. Salleha: A lot. There is very, very well-established evidence on how smoking affects fertility.
In men:
- Lowers sperm count
- Reduces sperm motility (movement)
- Affects the sperm’s ability to fertilise the egg
- Can impact placenta formation (since the placenta comes from the man, poor sperm quality can affect its development)
- May lead to smaller babies or restricted growth during pregnancy
In women, smoking is often used to suppress appetite or maintain weight, but it comes at a cost:
- Reduces egg quality
- Lowers the number of eggs
- Affects the development of good-quality embryos (baby cells)
- Lowers the chances of successful implantation
- Increases the risk of miscarriage
- Can affect overall baby development during pregnancy
Pregnancy can still happen while smoking, but it might jeopardise the baby’s growth or lead to complications like miscarriage. We’ve seen this in many cases.
1Twenty80: What are some of the other factors that affect fertility which people don’t usually know of?
Dr. Salleha: Most people take for granted the fact that fertility treatment exists, so they think they can always come later. But actually, fertility, especially for women, declines with age.
Nowadays, of course, many of us have careers and things we want to accomplish before starting a family. But by the time we’re ready, our egg reserve has already reduced. The quality of the eggs drops too. As women, we have a biological clock—more so than men. For men, it’s a bit later, around 45. But for women, it’s 35.
So when you start a family after 35, that’s when fertility issues become more impactful, or more affected. Compared to our grandparents, who most got married at 16, by 30 they already ‘closed shop’. So they didn’t feel the fertility decline as much because they started early.
We have to find the right balance between career and family. Nowadays, it’s hard for only one person to work in a household, and we understand that. But if you have the possibility of starting early, then start early. Career and all that can wait.
1Twenty80: As of now, do you think there’s enough awareness and support for conditions like PCOS or adenomyosis that can affect fertility?
Dr. Salleha: There is definitely much better support now than before, but we can do better.
There’s more awareness about PCOS now, which is good, because it’s not just a fertility issue—it has long-term impacts. For example, if it continues untreated, a woman with PCOS has a higher risk of developing diabetes, cardiovascular disease, and even cancer of the womb. This is because they don’t get their periods regularly. So if nothing is done about it, all of that might happen. The long-term impact goes beyond just fertility. That’s where we still need to improve awareness.
A healthy lifestyle is hard… because all our food are so delicious. All the viral foods are cheap and easy to get. So I honestly don’t know how to handle that situation.
1Twenty80: Do you notice any generational differences in how patients approach fertility? (eg. younger couples vs. late 30s)
Dr. Salleha: Now, people are more open, especially the younger group. They’re more willing to come straight to the doctor. The more mature ones tend to be a bit more reluctant.
When we take their history and ask how long they’ve been trying, sometimes it’s 5-10 years, and yet it’s their first time coming. That’s because they were trying other things first. But the younger group, after just one year of marriage, they’ll come check. So we’re seeing these two extremes.
1Twenty80: What sort of emotional or physical support do patients need during fertility treatments or consultations?
Dr. Salleha: I think understanding each other is very important, especially between a wife and husband. Especially more from the husband, if the wife is going through a lot of hormonal treatments.
For example, during IVF, the wife has to go through daily injections, frequent scans, and procedures. There are lots of do’s and don’ts that she has to comply with during that time. Many husbands are afraid of needles, so they’re unable to do the injections for their wife, so some have to do it themselves. But just having the husband there, to help with preparations, to hold her hand, to lend a shoulder or give a hug.. that’s enough, I think, for most women. Rather than leaving her to go through it alone.
It’s also important for couples to come to appointments together. Even if the husband doesn’t say much, even if he’s just there to drive, send, or help with parking, that’s all a woman really needs. She can go through the injections, but she just needs the support. That kind of support is more helpful than saying too much or, worse, blaming her.
1Twenty80: You also did mention that men are more likely to be more in denial, right? So what do you think is the correct approach to support them emotionally for that? the denial?
Dr. Salleha: Yes, the wife has to understand why men can be reluctant to come, because unfortunately, we don’t always have a clear answer for why his sperm isn’t doing well. So just be there, make sure he takes his supplements, and encourage lifestyle changes.. because it takes two. For example, if the man needs to avoid processed foods like hot dogs or burgers, the woman should avoid them too. There’s no point if only one partner is cautious, while the other is still eating those things—or even leaves fast food wrappers in the bin at home. At the same time, it can be difficult for the wife to ask her husband to come and get tested in the first place, as it’s very, very sensitive.
Although, even if it is the husband’s sperm count that is low, it’s still the wife who has to go through the hormonal injections. She’s the one who has to do IVF. So some women feel like it’s not fair, “It’s him, it’s his fault. Why am I the one who has to go through all the scans, injections, and whatnot?” But to retrieve the egg, we need to go through hormonal stimulation. They can’t just take it out like that. The egg has to be matured first.
For men, on the other hand, it’s usually just supplements, no injections.
1Twenty80: Fertility challenges can be physically and emotionally demanding, yet many people keep it hidden. Do you think there’s enough understanding or support in the workplace for people going through this?
Dr. Salleha: That’s a good question, actually. In international companies, they tend to have allocations for fertility. In fact, some have insurance that covers it. For example, big companies like Google or other American companies have that for their employees.
But on the other hand, none of our local insurance covers fertility. So that’s painful. When people need help the most, there’s no financial support. From the employer’s point of view, it really depends. Big companies tend to be more supportive, but smaller companies might find it difficult.. things like taking time off, or just having understanding from the management.
There’s also a lot of pressure. Some don’t know whether they should take full medical leave. We usually give them about two weeks and see, but they hesitate, because if they take that leave, people might figure out that they’re going through fertility treatment. And if it doesn’t work, it becomes even harder. On the first day back at the office, people might go, “Oh, she’s back,” and that alone can carry so much weight.
There’s a lot of stigma and emotional difficulty people have to face. Some choose to let their office know about it. Others don’t want to. In fact, even for their medical certificate, they’ll go to their panel clinic so that when they submit it, it won’t show that it came from a fertility centre. That’s how far it goes. Because of the stigma—or maybe just the pressure—they don’t want people to know they were at a fertility centre, especially if the treatment isn’t successful. Or in the case of a miscarriage, they still have to show up, carry on, and pretend nothing happened.
1Twenty80: What are some misconceptions you often hear from patients about fertility treatment?
Dr. Salleha: It’s always about the female.. that she’s infertile or barren, which is a very harsh word. But actually, half of the cases involve male factors as well, not just the female. Still, our people tend to blame the woman first.
1Twenty80: What advice would you give to someone who’s just starting their fertility journey and feeling overwhelmed?
Dr. Salleha: The advice is: keep on, keep it up. Keep the momentum going and keep trying as long as you can. Take a break in between if you need to, but then continue. One day, it will come to you.
Another advice is to start early rather than later. Ada calon, get married quick.
1Twenty80: As someone who shares online, what’s your take on how social media has shaped the conversation?
Dr. Salleha: I think it’s a blessing to have social media because we can reach couples directly, unlike traditional media, where we weren’t really able to.
Social media has opened a lot of doors for people to discuss personal, intimate, or sensitive matters more openly. And more people are becoming accepting, meaning they’re open and able to talk about these things together. For example, when we conduct online webinars, people don’t have to show their face or anything, but they can still ask questions. And so, people will know that they’re not alone in what they’re going through. There are many others in the same situation, and that they support each other.
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