Asia’s Fertility Crisis | Sastya Wardini | Tank Talks Asia

Sastya: If the fertility rate of Indonesia keep on dropping, it might face issues like in Singapore, Japan, and Korea, which, you know, they’re predicting there will not be anymore, you know, new Singaporeans, new Japanese, new Korean in the next future.

Manisha: Yeah it's a big worry.

Hello, it's Tank Talks Asia. I'm Manisha Tank, from me and the team at the AsiaWorks studio, a very warm welcome.

Now, imagine a world without women. Impossible, right? Without childbirth, it's over for us. Yet studies show women's reproductive health is overwhelmingly ignored, especially in Asia, and conversations about declining fertility, mostly amongst men, are being swept under the rug

From periods to PCOS, menopause to hormonal health, taboos abound. This isn't just a problem for society, but for the economy as well. The good news, though, is things are changing. This International Women's Day, we meet Sastya Wardani, the Indonesian entrepreneur and founder of Femtech company, Ovy Health. She's on a mission to change how women understand and care for their bodies, how society prioritizes that care, and to make men a part of the conversation.

Sastya, a warm welcome to Tank Talks Asia. So good to have you on the show, how’ve you been?

Sastya: I’m great, thank you for having me here.

Manisha: For those who don't know who you are, how would you describe yourself and your work?

Sastya: I'm a co-founder of Ovy Health. We are the first digital fertility assistant for women in Southeast Asia.

Manisha: So is Ovy Health an app, is it a platform? How does it work?

Sastya: So Ovy Health started as an app, but where we are changing the world of fertility with is because not only the app that we are building, but the whole ecosystem for fertility and hormonal health.

Manisha: Anyone who's followed you on Instagram will know that you've had a bit of a personal journey. I wanted to understand what led you to build Ovy Health in the first place.

Sastya: Both my grandparents are professor, like very early in, you know, Indonesia's life, I would say. But each family has their own fertility issue that, when I realized even, you know, 50 years after that, it still has not been solved.

From my dad's side, my grandpa was the first son after 19 years of marriage. They were trying for 19 years only to finally conceive, you know, the first son. And my grandpa always tell me that the reason why he fell in love with my grandma was because my grandma came from a big family. And he was hoping that because of their genes, he could have a big family as well.

Manisha: Right, right. Okay.

Sastya: From my mom's side, my grandma was known as a therapist, she was very well known around Indonesia for helping women to get pregnant.

Manisha: That is really fascinating, because that's sort of generations of knowledge handed down from one woman to another.

romonitor survey done back in: 2024

Sastya: This taboo comes also from a mix of religion, a mix of traditional knowledge or, I would say it's more like myth, because it's not exactly proven, but simply it all came because they didn't know what is exactly menstruation. Like what is exactly happening to woman's body when it's actually happening?

Manisha: Wait, how do you mean? So you say they didn't know. Who didn't know?

Sastya: You know the older generations. They know it's happening, but they never really understand how to actually manage it, what is actually going on behind menstruations, like how it fluctuates. What they know is like, your body's not functioning, well it's actually functioning very well if you're having menstruation.

Manisha: That's the irony, right?

Sastya: So what they know is like, okay, if you know back in the days if someone is having menstruations, that means you know, she's sick, she's dirty. She is not well, she's not supposed to be, you know, like touching people's food or like meeting people because maybe it's contagious.

Manisha: I get so frustrated when I hear that and I've heard it like in my own community as well, and I know it happens.

Sastya: Exactly.

ld War in Japan, for example,: 1947

Sastya: They simply dunno. It's not something that a lot of companies actually, you know, providing, they don't communicate about like menstrual leave. They don't communicate about all of these things because again, in the back of their mind, this is options between economy, you know, financials or health. Because again, like the fact that it is still taboo, they also don't wanna talk about it. It's something sensitive. It's some things that like, they'd rather avoid than having the conversation.

Manisha: And yet you’re building a business?

Sastya: Yeah.

Manisha: That relies on people talking about these sensitive issues. So how are you getting around that?

Sastya: It's been very challenging, like with the fact that even being present online, sometimes I can't even say the word menstruation,

Manisha: Really?

Sastya: A lot of things would, you know, get taken out of the internet just because I say it. For example, conceiving, trying to conceive.

Manisha: People are uncomfortable with that as a phrase.

Sastya: Yes.

Manisha: Wow. That's really surprising.

Sastya: And feel like for the fact that we have to change all of this words with like emojis, just shows how like, it is still something that's like uncomfortable for people to even see publicly online.

Like when I do that, our visions and our value lies in the fact that we believe fertile women are healthy women. So we keep on pushing on talking about what does it means to be fertile women? What is require?

Manisha: Coming up. The hormone everyone needs to be thinking about.

I was reading a few surveys and there are some big issues that don't get talked about enough, that are affecting women in Asia in a really big way. So for example, polycystic ovary syndrome. No one is talking about this, but it is ruining people's lives. What have you experienced in the research that you've seen, in the women that you've spoken to?

Sastya: Polycystic ovarian syndrome, PCOS, happens to one out of 10 women. The symptoms vary from something that is like very small and unseen, like not being able to ovulate and it is very unfortunate that a lot of these women don't even get diagnosed with PCOS. While some of the symptoms are very visible.

Manisha: Is that because the expertise isn't there for the diagnosis or that people don't wanna talk about it, or they themselves don't recognize that this might be something that they're going through?

Sastya: It's a combinations of all. So what we see, a lot of these women's cases, sometimes they suspect that they do have PCOS, simply because they read online that they do have the symptoms.

But testing for PCOS requires like a bunch of few things. One of our problem that we also see is, specifically in Indonesia, sometimes doctors don't really wanna suggest like an additional test, simply because they worry about the cost for the patient.

Manisha: Yeah.

Sastya: So for you to be diagnosed with PCOS, there's like multiple, it's not only one type of test and sometimes they do only one, which is not conclusive for this woman. And the only explanation that they could give is just one.

For example, oh, your egg follicle is small. That's just one of the symptoms, right.

So at the end of the day, all of these women suffer quietly simply because nobody has told them or like assisted them in getting diagnosed properly.

Manisha: Is hormonal health getting a bit more attention these days? Thanks to Instagram and TikTok and YouTube?

Sastya: I still see that there's a lot of opportunities for it to be understood better, I would say. People still consider hormonal issues as just mood issues.

Oh, you're just being hormonal. You're like moody now. You're like angry, you're crying and stuff. And as if like, there's that's the biggest issue about like hormonal health, which actually it is not.

Nowadays I also see a lot of people started talking about perimenopause, which actually, it's a hormonal issues, but then the way the conversations has built, has been built is, perimenopause solutions are HRT, which exactly, not the only one I would say.

There are still a lot of things that we need to understand about hormones, and I think the first step towards it is also to educate, especially the young girls, to understand what is exactly hormone and what hormones affecting, you know, like their life and their feelings and including like what they're actually feeling physically.

Manisha: If you go to the doctor's surgery, you'll often see leaflets, pamphlets, information about diabetes. Or you'll see information about blood pressure, something like that. But you won't see information about your hormones. You won't see information about menopause or perimenopause.

But actually, if you think about it, women spend a third of their lives in menopause. And yet we don’t talk about it, if you want information about HRT, you're much more likely to go and speak to one of your friends, a girlfriend, than you are to speak to the doctor because you're not encouraged to speak to the doctor.

Sastya: So we do see a lot of young womens trying to go to the doctor, understanding what is this exactly hormones, and there's no explanations that they were given to them in a very simple way.

It's all about the end solution and it's not really about, you know, what does it mean? But it's also understandable if we look at like how hormone works, everyone would experience different thing. There's a general things that they would experience, for example, like how is it when your estrogen's going up, what is it when it's like too low and, and so on. But everybody might, you know, feel it differently. And the first thing that they need to know, which is why I always say be an advocate for yourself, is don't be afraid to get tested, check your hormone regularly.

Manisha: That's possible is it? 'Cause a lot of people don't even know that you could have your hormones checked.

Sastya: Yes. For woman, they can do like a female hormonal panel that includes estrogen, progesterone, FSH, LH, and prolactin typically. There's an additional hormone that I always tell everyone to check that is AMH. Which specifically to see egg reserve. AMH stands for Anti-Müllerian Hormone.

It is accurate, but you might need like an additional test, to fully see how your egg reserve working, for example, like through an ultrasound, but you get an idea how much egg reserve you have and even this hormone people don't know and people don't talk about.

That's why a lot of women are only base off the age. And unfortunately a lot of young women now as young as 25, already have low AMH.

Manisha: So that is a signal of infertility, is it?

Sastya: Yes. That means they're going through perimenopause and they're probably menopausing in few years. Imagine girls as young as 25, thinking that they still have a long years ahead of them doing life, career, maybe looking for a boyfriend, for potential husband, not knowing that they don't even have that time if they're willing to consider that.

Manisha: Are you seeing more of this in the region?

Sastya: Yeah.

Manisha: Coming up, why the shocking drop in Asia’s fertility rates really matters.

What are the studies showing us about drops in fertility? 'Cause people are beginning to talk about this now. So perhaps we can look at it through the lens of infertility in women, but also infertility in men, and no one is talking about that.

Sastya: Statistically in Southeast Asia alone, there's only one country whose fertility rate is still above replacement rate. So a replacement rate is 2.1, which means that's the amount of, you know, like people conceiving and having babies, which require to maintain the number of population.

te. That's why even in end of: 2024

Manisha: Mm-hmm.

Sastya: What the Indonesian people don't understand is, there's a reason why the government advising to do that. It's simply because we are already falling behind in term of replacement rate.

If the fertility rate of Indonesia keep on dropping, it might face issues like in Singapore, Japan, and Korea, which, you know, the predicting there will not be anymore, you know, new Singaporeans, new Japanese, new Korean in the next future.

Manisha: Yeah, it's a big worry. Do we know why the fertility rates are falling?

Sastya: One reason is definitely economy. There's a lot of people starting to consider their family economics would be affected if they have kids or like even bigger family. But another reason that people don't really talk about, or even a lot of people don't really make a study out of it, is their infertility between women and men.

In the work that we do, we see an exact 50 50 between men and women, and in some cases it's both of them who has infertility issues. In the women itself, a lot of infertility happens with like PCOS or endometriosis and third most cases is the low AMH.

But in men, there's a lot of even like, you know, bigger things that, not exactly showing the symptoms, but it is equally hard when we talk about the infertility cases.

Manisha: Yeah 'cause a lot of men don't wanna talk about it. So how do you get past that taboo and address it from their perspective as well?

And again, what's causing this? Is this the environment? Because it's not, not all just economic, which is what you were saying earlier.

Sastya: Of course environment is a big thing when it comes to infertility. A lot of things that we actually expose ourself to, are not exactly good for our hormones or what we call as endocrine disruptors.

There's this one case of studies. It's basically is a news that came from Korea that a certain brand has such a high components that disrupting endocrines to the point that it can cause fertility. I mean, imagine your clothes can cause infertility.

Manisha: You would never even think about that.

Sastya: Exactly. But then a lot of this, like new behavior that we built can actually cause infertility as well.

Nowadays, a lot of men has infertility issues with, you know, the lack of quality in their sperm simply because they like to put their laptop on their lap.

Manisha: Right, a simple fix then.

Up ahead. Why it might be time to get a blood test.

There are a lot of people come to you, they wanna have kids. What's the advice that you give them, given everything that we've just talked about?

Sastya: People are still very much afraid of getting themself checked, as simple as like a blood test, a simple as like seeing doctors for ultrasound or even getting like sperm analysis.

Manisha: Mm-hmm.

Sastya: Because they don't wanna get the bad news. But I always tell them that it's better for you to know now than to know later, because if anything happens right now, it's a quick fix.

Science has improved so much, like studies about fertility getting more and more exposure. A lot of people are also trying to come up with like new things to help these people specifically. And there will always be a solutions that we can do for as long as you know what is your problem.

Manisha: You gotta know what the problem is.

Sastya: Exactly.

Manisha: You can't run from that information. And then you're on a timeline as well. So you said there are women as young as the age of 25 who are coming up as infertile, have those really low levels of hormone, that's really worrying.

Sastya: It is.

Manisha: When did that shift? Do you know from the studies, like when that started to happen?

Sastya: Unfortunately because there's not enough studies that's being done currently on like women's health. We don't exactly know.

Manisha: And particularly in Asia.

Sastya: Yes.

Manisha: Because I think a lot of the parameters were set in the United States or through data that's coming from Europe. I think one of the things that's really important that Ovy Health is doing, is you are collating a lot of data from the region. What's been some of the most surprising learning that you got from that data?

Sastya: This issue is bigger than any data that is available out there.

I would say, small sample size that we have right now, we see even bigger. The latest data about infertility happens to one out of six people and it has, you know, increased from last time it was one of eight, and now it's one of six.

And that is just like the data that is like collected globally. But from the cases that we receive, I think it could be one out of three. Honestly.

Manisha: That's the direction that it's going in?

Sastya: Yeah.

Manisha: So anybody who's listening to this and doesn't wanna be caught in that trap down the road, what would you say to them? What should everyone be doing? How early in our lives do we need to think about it? Is it something that should be in school textbooks, for example?

Sastya: I do believe so. The moment a girl hit puberty, they have to understand that menstruation is not just about, you know, having blood coming out of their body, it's also about their hormones. I think it's very, very important, especially for like the young mothers like nowadays who have young daughters. They need to understand for themselves and also for their daughters.

Manisha: Yeah, yeah.

Sastya: Because these things, changes in like a woman's life stage, it's different when it's in their puberty. It's different when it's in their adolescence. It's different when it's like, you know, closer to their thirties and even above thirties.

The point is that we need to be able to advocate for themself and really understand what does it means for our health and our body. Think of it this way, for a men, there are only four vital sign. But for women, there's a fifth one, and this fifth one is your menstrual and hormonal health.

Because for men they do have hormones as well, but it works differently to their body. While to women hormones also works, not only regards to their menstruation health, but also in the way their brain works, the way their heart works, the way everything in their body works. Right now, anyone listening to this and thinks like, oh, I don't even understand about my hormones, it is still a good time for them to try to understand it.

Manisha: Anytime is a good time.

Sastya: Exactly. It's still better than, you know, being too late to understand about it and only happen when it's already well, too late.

Manisha: Perhaps, rather selfishly, and me being of a certain age, I've become much more interested in hormones because I've noticed things about my approach to life, about my reactions to life, which are really different to before. You know, things like brain fog. I couldn't even remember the name of someone that I've interacted with so many times. Or just feeling like you cannot get focused or feeling much more tired than usual.

I thought there was something wrong with me. I feel weak. I think that that is one of the biggest problems that we've got, is we have to stop thinking about it this way.

Sastya: I totally agree. These things about us that's very unique, has always been associated as being weak. Right. Like when we were younger, you talk about menstruation and then they said, you know, this week you're probably not gonna be productive. You're probably gonna feel like sick. You're probably gonna feel that this and that. But then when we get older, all of this works differently again. So sometimes this so-called weakness or like changes in your body doesn't happen only when you're like during the period.

The thing about these hormones itself, when it doesn't work well, it kinda make you feel like you are not fully fit. I wouldn't say sick because sometimes it just make you feel like, not really feeling like going out, for example. Or maybe like not being able to lift heavier weight at the gym.

I think the reason why it only like happens to, let's say like a more mature woman talking about it because it makes them then realize that these changes can affect significantly in their life because it started to disrupt their activities.

Manisha: Yeah. And it affects families.

Sastya: Of course.

Manisha: I have to tell my family sometimes, like I'm in a bit of an irritable mood. So stay away during that window of irritation, it's probably not gonna be good for you.

Before you go, because we're gonna have to wrap this up soon, I did want to talk about practicalities. What have you found in your research?

Sastya: One thing that we also see very important and people don't really talk about is our cortisol. Another hormones. People think that being stressed is bad, but they never really understand why stress is bad and how stress can affect our body.

But there's this thing like in our hormone called cortisol, that when it is too high because there's a certain stress that the body is experiencing, it makes your body stays in, you know, fight or flight mode. And so it stops reacting or like working the way it's supposed to be, and not only in term of like fertility, but also everything else.

For example, like what some people might be experiencing is like hair loss, dry skin, you know, storing fat in their abdomen and like a bunch of other things, which eventually could also show as one of the symptoms of infertility. But that is, still need to be managed and does still need to be taken care of.

Because of that, one of the things that Ovy Health built as a first, very first line is to fix this cortisol issue.

Manisha: Oh, it can be fixed, can it?

Sastya: There's a lot of activities obviously, that you can do to manage this cortisol hormone. But we are also working on a cortisol support supplement that can help to naturally reduce. The ingredients is a mix of three types of vitamin B, including like a few other things like magnesium and our signature is a cortisol herb reducer. But the way that it works, it helps to not only balance this cortisol level, the point of balancing this cortisol level is so that your body can accept every other things that you require. For example, one thing that I would always suggest to women is like folic acid.

Manisha: I mean people only ever prescribe it to you when you are going to have children.

Sastya: Yeah.

Manisha: But you are saying that we should all be taking folic acid anyway.

Sastya: Yeah, it's very good. Of course, that it increase the quality of egg. But then at the same time, it's also a kind of antioxidant. It helps for everything else.

Manisha: Definitely very useful. I'm sure that people can find out more. They can look it up.

Sastya: Yeah.

Manisha: Ovy Health website. It's a whole platform. There's lots of information. I think last question really is, what's the call to action in a way? Because we've discussed a lot about the conversations around reproductive health, women's health, taboos and how people don't wanna talk about it.

But I wanna end on a positive note really. Because it sounds to me like there's a lot of really good work that's happening. Where do you see us 10 years from now? And what would you say to people who are listening to this who want to get on top of this?

Sastya: First, be an advocate for yourself, and then be an advocate for the closest person next to you. You can always think about like, be the advocate for your mom. Because the moment we start thinking about it as a health, not just women's health, not just fertility health, we will be able to also see how it is very important for everybody's life, everybody's health, even like the nation's, the family and so on.

And there's like a lot of problem nowadays. I'm very, very positive that it will be better in five years, even, not like 10 years.

Manisha: That's great.

Sastya: By looking at like how a lot more women and men trying to be an advocate for this type of health, soon we will be able to talk about it as if it is just like, headache.

Manisha: Or how about more positively going to the gym and taking your health in your own hands and improving it? Yes. I hope.

Sastya, it's been lovely. Thank you so much for joining us.

Sastya: Thank you for having me here. It's been great talking about it.

Manisha: I've gotta admit there was quite a bit there that surprised me, but one thing is for sure, I'm definitely going to address my hormonal health and encourage all of you to do the same as well.

That's it for this episode. We really appreciate you listening all the way through, and don't forget to check out our show notes. There you'll find relevant links to everything that we've mentioned, in case there's anything you'd like to follow up on and please do subscribe and follow Tank Talks Asia, that way you'll never miss an episode.

I’m Manisha Tank, from me and the AsiaWorks team, thanks again for your time.

Tank Talks Asia is an AsiaWorks production and the views and opinions shared by our guests are their own.