While many couples may indeed conceive naturally with time, there are some factors that will inevitably necessitate medical intervention. — Positive Parenting
We are shrinking.
Yes, we are.
Malaysia’s overall fertility has been trending downward for decades, reflecting a wider demographic shift that includes urbanisation, later marriage and changing socioeconomic patterns.
According to the Statistics Department’s Vital Statistics Malaysia 2025 (reporting on 2024 data), the overall national total fertility rate (TFR) is 1.6 children per woman (down from 1.7 in 2023).
TFR by major ethnic groups in 2024 are:
- Malay: 1.8 children per woman
- Other Bumiputera: 1.6 children per woman
- Indians: 1.2 children per woman, and
- Chinese: 0.9 children per woman.
These data shows that our overall fertility rate is not enough to replace the loss of our population.
A healthy or replacement-level TFR for a country is generally around 2.1 children per woman, which allows a population to replace itself without migration.
When to seek help
We need to take action now to curb this fertility decline.
In my two decades of experience as a fertility specialist, I have noticed that couples are generally confused as to when to seek help.
It does not matter if you are from Gen X, Gen Y or Gen Z, I see a common pattern in all of them.
The couple does not know whether to seek help immediately or to wait for a natural conception to happen.
While I agree that, with time, many couples can get pregnant naturally, this is not true in all cases.
Let me illustrate this with the following two scenarios.
First is when the couple is older, especially if the female partner is more than 35 years of age.
In such a case, do seek help immediately, or at the latest, after six months of trying to conceive naturally, provided neither partner has any known infertility factors such as endometriosis, irregular periods, polycystic ovarian syndrome (PCOS) or male factor infertility.
Second is when a woman has irregular periods, or regular periods due to treatment.
A common cause of irregular periods is PCOS.
ALSO READ: PCOS is a common cause of irregular periods
A woman’s natural period indicates that she is ovulating.
If your period is irregular, it indicates that you are not ovulating regularly.
Women tend to think that if they can regulate their period cycle with medications, they are ovulating.
Sounds about right, but you are totally wrong.
A regular period cycle induced with medication is not your true period.
It is an artificial period and you are still not ovulating, therefore, there is zero chance of getting pregnant.
Women with irregular periods need to control the underlying root cause, such as PCOS.
Subsequently, she needs help to induce an egg to grow and ovulate.
This can be done with simple oral medications.
So, a young woman with PCOS and irregular periods should seek help immediately if she wishes to get pregnant.
This gives ample time to control the PCOS earlier and induce ovulation while she is still young.
This crucial step will save money in a long term by avoiding expensive treatments later in life.
Avoid these pitfalls
When a couple seeks help from a fertility clinic, do remember that the clinic has limitations.
The first pitfall is not to make the mistake of thinking that modern treatments will automatically change your fertility health for the better.
You need to take an active role in your own fertility journey.
Both of you can actually help yourselves make a difference.
Yes, I am talking about lifestyle changes that many couple tend to ignore to some extent.
Please do not underestimate the significance of lifestyle changes on your fertility health.
Practising healthy habits works hand in hand with recommended fertility treatment regimes.
Overall, a healthier you increases the success rate of your fertility treatment.
ALSO READ: When an obese mother leads to an obese child
Another common pitfall is seeking advice or treatment from unregulated “fertility clinics”.
Not every establishment or “clinic” that calls themselves a women’s clinic is a fertility clinic.
In the era of social media, these false claims are easily spread online.
At a licensed fertility clinic or fertility centre, the treatments are planned by a gynaecologist (a doctor specialised in women’s health, especially in the female reproductive system), who has done training in the field of reproductive medicine.
Qualified gynaecologists registered in the field of reproductive medicine and licensed to practice in Malaysia are listed in the National Specialist Register (NSR).
I have personally seen many couples who not only wasted time and money seeking treatment from unregulated bogus “fertility clinics”, but also received hormonal or lifestyle interventions that do not make sense scientifically.
In fact, some couples were “treated” by individuals who are just selling fertility products.
Some of these individuals are also acting as “fertility agents” who promote fertility regimes abroad, which, most of the time, can be very expensive and not necessarily effective.
Please do check the credibility of the clinic or “doctor” that you are seeking treatment from to avoid being misled.
Many couples do seek initial consultation with general practitioners (GPs) who have the knowledge of initial fertility tests.
This is an acceptable first step.
However, a specialist consultation should be sought after the initial basic treatment, such as an ovulation induction, is not successful.
Timely referral from GPs to a fertility specialist could save time and money for the couple.
Honest advice
Medical evidence and treatment regimes for infertility will undergo evolution over time.
But what is constant is your effort to conceive.
Regardless of how difficult your own fertility struggles may be, remember that to achieve a pregnancy, both the egg and sperm cells need to come into contact either naturally, or via intrauterine insemination (IUI) or in vitro fertilisation (IVF).
Inaction leads you to nowhere.
See StarLifestyle on Jan 26 (2026) for the latest fertility tests and treatments.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
