TTC: Trying to Conceive Part 2
I have the immense privilege of being a part of the fertility journey of many birthing people. Not only cisgender, straight women conceive and nourish fetuses inside their bodies; many birthing people are transmen or cis queer women. I will take this time to detail how different people living in different bodily environments can optimize and understand their fertility better to potentially expand their family should they wish to do so.
Conceiving is more difficult than we are led to believe in junior high health class. In a National Institute of Health study, 204 cis women were polled about fertile windows during their menstrual cycles. Only 13% of the polled individuals correctly identified the window of the cycle in which one would be able to naturally conceive. That means that 87% of the participants weren’t fully educated around their fertility which could lead to unnecessary intervention, disappointment, and delayed planned pregnancy.
For cis women, the fertile window is generally mid cycle, around day 14-16. Day one of the cycle is the first day of bleeding, and it is considered normal to bleed for 4-7 days. Each cycle should be 28-32 days long from day one to the next day one. Making sure that a cycle is fairly regular is step one. By focusing on stress resiliency, regularity can be improved. Both stress hormones (cortisol) and sex hormones (testosterone, androgens, estrogens, etc.) are made from cholesterol as a precursor. If stress is high and the body is pushed to make more cortisol, the sex hormones will be impacted, potentially making a cycle irregular or delaying ovulation.
Incorporating meditation, yoga, breathing exercises, communicating boundaries both at work and at home, delegating tasks, and getting adequate sleep are great tools to address stress. Keeping track of the cycle via an app like Flo or Clue can ensure you track your efforts. Utilizing ovulation predictor kits around days 8-18 can help track and pinpoint ovulation. Doing this for at least 3-6 months can be useful to not only track regularity and hormone changes but can also be a tool to time sex. A cis woman is most fertile 3-5 days prior to ovulation and day of. Outside that window of time, it is unlikely that conception will occur.
For queer cis women looking to conceive, many of the aforementioned steps are important and may also pertain. There are many ways to inseminate. One can use penetrative intercourse, a sperm donor insemination, IUI, or IVF. If utilizing penetrative sex, having sex around the ovulatory window is the best bet. For a sperm bank/cryobank, it is important to be sure they partner with verified fertility institutes, they blood type test, and run genetic testing and STD testing screens. Defaulting to an anonymous donor is usually the best choice as legal issues can arise with a known donor down the line. Choosing a smaller boutique fertility medicine company can center the patient and avoid large clusters of patients all artificially put on the same cycle schedule. It can allow for more natural cycling, less medication use, and therefore less stress and side effects.
For a transman, it is important to consult with an endocrinologist to make sure that he is being taken care of hormonally and emotionally. Using language around conception and the body that feels safe and comfortable to the individual is paramount during this process. Testosterone will need to be discontinued (if being taken) and hormones should be monitored closely. If utilizing IUI or IVF, be sure that the fertility center has experience and knowledge surrounding transitioned/transitioning bodies. Note if their forms have a section for pronouns, if the staff introduces themselves and provides pronouns with introduction, if questions about dead names or non pertinent medical details are solicited. All of these things would be clues to see how the staff and doctors would support a birthing person who identifies as a transman.
In short, hormones are complicated, and expanding a family can look vastly different to different people. We at Willow + Elm will support your fertility and family planning endeavors with respect and joy. If you have further questions, feel free to book a free consult via our online portal and booking system!