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Blog | Alto Pharmacy

All air quality significantly impacts your respiratory health, not just outdoor air pollution. Indoor air is often filled with irritants including smoke, allergens, and chemicals. These substances can irritate the lungs and airways, causing inflammation and reducing lung function, which refers to how well your lungs work.

How to Improve Indoor Air Quality at Home

Given that the average American spends approximately 90% of their time inside, it’s important to keep the air inside your home as clean as possible, especially if you are susceptible to seasonal allergies or have respiratory conditions such as asthma or COPD.

Use the simple precautions below as a starting point for better breathing at home.

Exposure to secondhand smoke, or exhaled cigarette smoke, adversely impacts respiratory health. It is a contributing factor to the development of COPD and may also cause a flare-up of COPD symptoms, also referred to as an acute exacerbation. For some individuals with asthma, secondhand smoke can trigger an asthma attack, which is defined by sudden shortness of breath and difficulty breathing.

Thirdhand smoke, or the residual smoke that remains on clothing or surrounding indoor surfaces after a person smokes, is an additional health risk that affects air quality.

Avoiding all indoor smoking is one of the most important actions you can take to improve indoor air quality at home. Of course, outdoor smoking also contributes to lung diseases. In addition to limiting your exposure to secondhand and thirdhand smoke at home, ask your doctor for support with smoking cessation if needed.

2. Avoid cleaning products with certain chemicals and strong scents.

Certain household products are worse for your respiratory health than others. Some disinfectants, personal hygiene products, and cleaning supplies contain chemicals known as volatile organic compounds (VOCs), which can tighten the airways and make it more difficult to breathe. Examples of common VOCs include formaldehyde, benzene, and toluene.

Ammonia, hydrogen peroxide, and chlorine bleach are other chemicals that should be avoided, along with scented products.

As an alternative, opt for natural, non-toxic products. You may even be able to create cleaning solutions from ingredients that are already in the house. Try using baking soda or a mixture of soap and water to scrub and wipe down surfaces. A combination of vinegar and water can be used to clean glass.

If you are using a product that contains a VOC or other harmful chemicals inside of your home, ventilate the area as much as possible by using exhaust fans and opening windows and doors. ​​You may also want to invest in an air purifier, which extracts irritants from the air.

Household allergens including dust mites and animal dander can trigger asthma symptoms and COPD exacerbations. Unfortunately, dust mites love to make themselves comfortable in your pillows and blankets as much as you do, so regularly wash pillows and bedding. Consider using dust mite pillow and mattress covers.

It’s best to vacuum at least once a week, ideally with a high-efficiency particulate air (HEPA) vacuum that catches smaller particles like allergens. An air purifier can also be used to remove allergens from indoor air.

During prime allergy season, avoid bringing pollen inside by changing and washing your clothes and removing your shoes after time outdoors. Dry clothes in a dryer instead of on a clothesline, where they’re likely to gather more pollen.

Dust mites aren’t the only indoor allergen to avoid. Mold exposure can also intensify symptoms of allergies, asthma, and COPD.

Moisture is typically the underlying cause of mold growth inside the home. As part of your allergy-proofing efforts, use a dehumidifier to keep indoor air dry during more humid seasons. (This can also help keep the dust mites away!) Keep bathrooms well ventilated and remove any visible mold as quickly as possible.

In addition, try to increase ventilation in the bathroom and kitchen, as well as other areas where steam accumulates. Use a fan or crack open a window when showering or cooking.

5. Clean air filters and increase ventilation.

There are steps you can take to keep clean air flowing throughout your home as much as possible.

First, change any filters in your home’s heating and cooling systems on a regular basis. If your house or apartment has a forced-air heating system — which uses air ducts and vents to circulate temperature-controlled air throughout your house or apartment — it’s especially important to change the filters regularly.

In addition, make sure that any air ducts inside of your home are clean, since they are a frequent source of dust accumulation.

If pollen is low, opening windows to let outdoor air flow throughout the building may also help improve indoor air quality. Most weather apps include a local daily pollen count.

Alto Pharmacy is here every step of the way to help you manage respiratory conditions like asthma, COPD, and allergies. Our team of pharmacists is available to answer questions about your medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

Reach out by phone at 1-800-874-5881 or in-app messaging to learn how we can support your treatment plan.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

While fertility treatments like in vitro fertilization (IVF) have become an increasingly common path to parenthood, helping millions of individuals conceive throughout the past four decades, they remain a significant financial investment.

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

Fertility medications used to support egg production, retrievals, and implantations frequently factor heavily into the overall cost of treatment. An average IVF cycle costs between $10,000 and $15,000, with medications an additional $5,000 or more depending on factors like a patient’s age and health history and a clinic’s treatment approach. Unfortunately, a portion of these medications often go unused, as many fertility treatment plans involve last-minute medication changes unsuited for the traditional retail pharmacy model.

As part of our commitment to your financial well-being, we offer a medication management experience that reduces fertility medication waste to lower the cost of treatment, developed in collaboration with Progyny. Take a closer look at our approach.

IVF is a process in which eggs and sperm are fertilized and then placed into the uterus with the potential outcome of a pregnancy. Multiple medications are used on a precisely timed schedule to grow follicles — fluid-filled sacs in the ovaries that potentially contain an egg — retrieve eggs, and, finally, implant a fertilized egg into the uterus. 

Here’s a snapshot of a typical IVF medication schedule:

Days 1-4: stimulation medications such as Gonal-f®, Follistim®, Menopur®, or Low-Dose hCG to stimulate egg production, so that you produce multiple follicles

Days 5-10: continuation of stimulation medications and introduction of antagonists such as Fyremadel™ (ganirelix acetate) and Cetrotide® to prevent premature ovulation

Days 10+: trigger shots of leuprolide acetate, Ovidrel®, and/or Novarel®/Pregnyl® to stimulate final growth spurt and ovulation

After transfer: estrogen and progesterone to support successful implantation of the embryo

Fertility medications are complex, with nightly dosages dependent upon hormone levels measured through bloodwork and ultrasounds. Not only do medication protocols vary from one individual to another, they are typically adjusted throughout the course of a cycle as hormones fluctuate.

Unused medication during fertility treatment

To prevent any missed doses, providers typically prescribe all medications that could be needed in bulk at the beginning of fertility treatment. However, dosages often decrease once a cycle is underway based on a provider’s discretion, ultrasounds, and bloodwork.

At traditional pharmacies, patients undergoing fertility treatment might end up paying for unused medication, as all potential medications are filled upfront. This contributes to the $5.4 billion epidemic of medication waste in the U.S. — one that is particularly acute in fertility, leading some individuals to buy and sell excess medication to each other on social media sites.

Our approach to fertility medication management

Alto has partnered with fertility benefits manager Progyny on an algorithm-powered, app-based medication management experience that reduces unneeded fertility medications while protecting the integrity of time-sensitive and personalized treatment plans.

First, we collect fertility cycle information through the Alto app and run the data through the Progyny algorithm to determine exactly what medication volumes are needed for the next phase of treatment. We then prepare a custom order for just the medications that are immediately needed, which are then delivered directly to your doorstep by our courier team. 

You will receive multiple deliveries throughout the course of your cycle, determined by your specific dosing, trigger schedule and other inputs from your clinical team. Carefully timed check-ins and local courier delivery make last-minute adjustments possible. This approach allows you to manage your medications as your IVF cycle progresses, giving you more control over the total amount of medication that you fill.

Additional financial resources for fertility medications

Alto is committed to helping you save as much as possible on your fertility medications. In addition to our personalized medication management approach, we’ll automatically search for savings and connect you with programs that require you to apply directly, including patient assistance programs from fertility medication manufacturers.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono or Ferring Pharmaceuticals. EMD has several programs that lower the cost of fertility treatment, including the Compassionate Care program, which offers income-based assistance for fertility medications that aren’t covered by insurance, and special opportunities for military veterans and cancer survivors.

Ferring Pharmaceuticals also offers financial assistance programs to offset the cost of fertility medications, including the HeartTomorrow program for individuals who elect to freeze their eggs, and special opportunities for military veterans and cancer patients.

Read Managing the Costs of Fertility Treatment for more on Alto’s financial support for fertility treatment and medications.

Choose a flexible and reliable pharmacy partner

Fertility treatment can be challenging, but we’ll be with you every step of the way. To ensure that your treatment plan is followed correctly, we offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

Interested in learning more about how Alto can support your fertility treatment? Request a price quote online or reach out through secure in-app messaging or by phone at 1-800-874-5881.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.

Get to know Jake Moffatt, Engineering Manager on the Alto Assistant Team

When Jake Moffatt says he loves building things, he means it — sometimes literally. A construction project manager turned engineer, Jake has spent the past decade building software at mission-driven organizations. Today, as Engineering Manager of Alto Assistant, he leads the team that’s bringing wizard-like support to Alto’s customer-facing app.
Below, Jake chats with fellow engineering manager Mike Riess and recruiter Braden Hanlon about the work ahead for Alto Assistant.

I’d love to learn more about your background to get us started. How did you end up in software engineering?

When I was twelve, I started learning to code in QBASIC because I wanted to make video games. Once I wrote my first program, I was hooked! I loved computers and the creative power they gave to anyone willing to invest the time and energy to learn. Since then, I’ve built games, personal tools and projects, desktop software, and a number of apps and services — I love building things. My career has gone back and forth between construction and software engineering, but it’s been firmly in the software industry for the last ten years or so.

My favorite place to be in a company is working on something new that has a big impact or addresses an important problem. In a previous role, I built an app that helped people find roommates in a city where housing is prohibitively expensive. At that same company, I led the team responsible for creating a new vertical that eventually split off into its own company.

The goal of Alto Assistant is to help customers help themselves before reaching out to support. Our first project is introducing a wizard-like support “assistant” (hence the team name!) that guides the customer through a series of questions to narrow down the area of support. We’ve already identified a few tasks the assistant can help customers complete on their own, including making changes to upcoming deliveries or scheduling new orders.

In cases where we can’t help them just yet, our new tool generates data to help us to learn exactly what customers need help with. It’s a top priority to bake analytics into every new feature we build; even though we have years of experience supporting our customers — and we know intuitively which problems they frequently experience — we don’t have conclusive data to draw upon just yet.

We plan to start with a couple of frequent use cases and measure how often customers reach out to us for support. Then, we’ll chip away at the problem until we’ve seen a substantial improvement in the user experience. From there, we’ll move on to the next biggest problem and repeat the cycle. There’s a reason “Chip away it” is an Alto value: It’s the playbook that we’ve used to automate other critical parts of the pharmacy value stream like intake, billing, and fulfillment.

What opportunities are you most excited about?

Support drives much of the cost of every shipment today, so this is a high-impact area for our business. A year from now, it would be a stellar outcome if the Assistant team could reduce the number of issues that customers need support on by half.

We’re also thinking about the user experience beyond the app. We plan to improve the tooling that our care specialists use to provide support as well. We’ve already discussed some promising ideas like creating the concept of a conversation in support communications rather than an infinite stream of messages and building out enriched communications. We also intend to develop a custom tool that can expedite a customer’s prescription when they need their medication ASAP.

The possibilities are many, and it will take a team of determined, passionate, empathetic people to solve these challenging problems. I’m super excited to see what the Assistant team will do together.

Any lessons learned from previous experience that you’re applying to your role at Alto?

There’s always the temptation to tackle everything at once with new business initiatives. My experience leading new verticals at Apartment List and Snapdocs taught me the importance of being laser-focused on one or two key metrics instead of trying to build out a fully-realized product from the beginning. That’s exactly what we’re doing on the Alto Assistant Team with our clear focus on reducing communications per shipment — how often customers reach out for help because they could not find what they needed in our app.

It’s also important to recognize that we won’t have all the answers right out of the gate! I like to think of product development as a three-step sequence: learning, growth, and maintenance. Alto Assistant is so young that we’re very much still in the learning phase. We maintain a tight iteration loop with everything we ship: launch, measure the impact, and use the results to iterate and refine our hypotheses about what our users want. Our final product could be anything from a customer support wizard to an AI chatbot to a ticketing system — we have to rely on our key metric of communications per shipment, experimentation, and user feedback to shape the direction.

What got you excited to join Alto? What would you pass on to an engineer thinking about applying to the company?

I was impressed by the Altoids I met during the interview process. I knew I would be working with people from whom I could learn a lot, like Elnaz, who started as an individual contributor and went on to become Director of Engineering and, now, Alto’s first Head of Strategy & Operations. I was also impressed by the quality of the interview process itself — a good sign that the company was well-organized internally. Finally, the pitch for the role was extremely clear, with already-established key metrics that would directly contribute to the company’s bottom line and help Alto become more profitable.

For engineers, I think Alto is a great place for both technical challenges and career growth. We’re still small enough that every individual gets exposure to a broad portfolio of high-impact projects. It’s also a great environment for learning about how a business works — the Product & Technology organization does a great job of sharing information and presenting problems in a way that gets to the root business problem we’re trying to solve. There’s a clear line between any project a team is working on and a foundational business metric. Most importantly, we’re a company that makes a truly positive impact on our users’ lives.

Interested in learning more about engineering at Alto? Follow us on LinkedIn.

Osteoporosis is a condition that weakens bones, increasing your risk for unexpected bone fractures, often of the hip, wrist, or spine. It affects an estimated 200 million people around the world, including 54 million individuals in the U.S. Though it isn’t curable, there are a variety of treatment options that can help protect and strengthen your bones. Read on to learn about the leading causes and treatment options of osteoporosis.

Osteoporosis, Explained | Alto Pharmacy

Your bones are constantly changing. When you’re young, new bone forms more quickly than old bone is lost, increasing your overall bone mass. This process starts to slow over time — typically beginning in your early 20s — and as you age, the reverse happens. Old bone disintegrates more quickly than new bone develops, decreasing your overall bone mass.

For those with osteoporosis, these changes are more pronounced, with lower than average bone mass and density. The inside of healthy bone resembles a honeycomb or a sponge, with many tiny holes. Osteoporosis, which means “porous bone,” gradually increases the size of these holes, lowering bone density and strength. As bones grow weak, brittle, and more porous, they become increasingly susceptible to fractures.

The condition is progressive. Without effective treatment, it may worsen, increasing your risk of a fracture. In cases of severe osteoporosis, even sneezing or minor bumps can fracture bone.

Osteoporosis is often preceded by a condition called osteopenia, which is characterized by less severe loss of bone density. Not all cases of osteopenia progress into osteoporosis, and simple lifestyle changes can help protect your bones and preserve bone mass. Regular bone density tests every two to three years are also an important component of osteoporosis prevention.

Sometimes referred to as a silent disease, osteoporosis often presents without noticeable symptoms. When symptoms do appear, they may include the following:

Posture changes such as stooping or bending forward

Since osteoporosis isn’t always accompanied by symptoms, it’s important to stay on track with bone density screenings as you age, especially if you are at increased risk for the condition. Many people first learn that they have osteoporosis after a fracture. If you have a family history of osteoporosis or a related health condition (see below), speak with a healthcare provider about your risk and recommended screenings.

Osteoporosis may be caused by a variety of factors, both preventable and non-preventable. Age and sex play the greatest role in the condition’s development. The condition affects women four times more often than men, and postmenopausal women have the highest risk of developing osteoporosis. This is due to how decreased estrogen levels after menopause alter the rhythm of bone remodeling, in addition to the overall aging-related loss of bone mass.

Though osteoporosis affects more women than men, everyone’s risk increases with age. Men over the age of 50 are significantly more susceptible to osteoporosis-induced bone breaks or fractures than those of a younger age.

The following factors may also contribute to the development of osteoporosis:

Bone structure and body weight — those with less body weight don’t have as much bone to lose and face a higher risk for osteoporosis.

Other health conditions including overactive thyroid, parathyroid, or adrenal glands; celiac disease; and inflammatory bowel disease

Previous hormone treatment, including for breast or prostate cancer or an irregular menstrual cycle

Previous bariatric surgery or organ transplant

Lifestyle factors including a history of smoking, alcohol use, a sedentary lifestyle, or calcium or vitamin D insufficiency

Bone mineral density (BMD) tests — also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans — are used to identify bone health issues in advance as well as to diagnose osteoporosis. 

A DEXA scan uses small amounts of radiation to assess the solidity of spine, hip, and wrist bones. Regular X-rays can only detect osteoporosis in more advanced stages.

This screening is recommended for all women over the age of 65 and all men over the age of 70, regardless of other risk factors. It may be recommended for postmenopausal women and men between 50-70 years old if other risk factors are present. Consult with your doctor about your preventative health needs and recommended screenings.

Treatment for osteoporosis varies by individual. Your doctor will make tailored recommendations about medications, diet, and exercise based on your needs. A treatment plan may include the following components.

Oral and injectable bisphosphonates, which prevent the loss of bone mass, are commonly prescribed for osteoporosis. Examples include:

Hormone therapy including estrogen and testosterone can also stop bone density loss. Estrogen has been associated with an increased risk for blood clots, certain cancers, and heart disease, and is typically reserved for younger women or women with menopause symptoms.

A medication called raloxifene (Evista®) offers similar benefits as estrogen therapy, but without many of the above risks. However, it is also associated with a higher risk of blood clots.

Three anabolic agents — romososumab-aqqg (Evenity®), teriparatide (Forteo®), and abaloparatide (Tymlos®) — are FDA-approved to treat osteoporosis. These medications support new bone formation and are administered as injections.

A biologic called denosumab (Prolia®) may be prescribed if other treatments aren’t effective. It is administered as an injection every six months.

There’s anecdotal evidence that some supplements can support bone health, however, research is still evolving, and few studies formally support the effectiveness of supplements. Speak with your doctor before taking supplements, as they may cause side effects or interact with other medications.

Nutrition significantly affects bone strength and health. Calcium and vitamin D are the two most important nutrients for managing osteoporosis. Calcium helps maintain strong bones and vitamin D allows your body to absorb calcium.

Nutritious sources of calcium include low-fat dairy products and dark green leafy vegetables. Vitamin D can be found in trout, salmon, and vitamin D-fortified milk and cereal. Some individuals get some of their vitamin D from sunlight, though this depends on your location and exposure to sunlight.

The recommended daily intakes for calcium and vitamin D vary by individual. General guidelines are below, but always check with your provider about your recommended intake.

Women with postmenopausal osteoporosis: 1200 mg of calcium and 800 international units of vitamin D

Women with premenopausal osteoporosis or men with osteoporosis: 1000 mg of calcium and 600 international units of vitamin D

Some evidence suggests that excess calcium consumption may cause kidney stones, calcium accumulation in blood vessels, and constipation. Always consult with your healthcare provider before taking supplements.

Other nutrients that promote bone health include:

Magnesium - found in whole grains and dark green leafy vegetables

Vitamin K - found in dark green leafy vegetables and canola oil

Zinc - found in whole grains, poultry, and nuts

Exercise is also part of living with osteoporosis. While certain types of exercise should be avoided given the risk for injuries, others offer many benefits for those with the condition.

Weight-bearing aerobic activities — performed on your feet — strengthen bones in your legs, hips, and lower spine. This includes walking, dancing, and low-impact aerobics.

It’s important to maintain good stability and balance. Try simple balancing exercises like standing on one leg or movement-based stability exercises, such as tai chi.

Unless otherwise informed by your doctor, avoid high-impact exercises and activities that involve frequent bending or twisting, as they may increase your risk of fractures. Always check with your doctor about which exercises are appropriate for you.

Take precautions to prevent falls both inside and outside of your home. You may wish to consult with your provider about whether or not they recommend an assistive device to improve balance and increase mobility.

Use the tips below as a starting point to prevent indoor and outdoor falls.

Avoid cleaning products that leave the floor slippery

Keep the area surrounding your house or apartment in good condition and free of clutter

The Bone Health & Osteoporosis Foundation (BHOF) and American Bone Health offer support and community for individuals living with osteoporosis.

Life with osteoporosis is easier with a reliable pharmacy partner by your side. Our pharmacists can answer any questions you may have, from medication side effects to navigating lifestyle changes. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with your treatment.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Alto’s board of advisors was formed in 2020 to deliver strategic guidance as we work toward a better healthcare system for all. With diverse leadership experience in the industry, our board of advisor members ensure that our efforts are both impactful and efficient, with services grounded in the highest standards of operational excellence.

Meet the Newest Members of our Advisory Board | Alto Pharmacy

Today we’re thrilled to welcome three new members to the board of advisors: Adam J. Fein, Harry Leider, and Brad Fluegel. Their passion and expertise will no doubt be an asset as we focus on reaching even more patients — and delivering even more comprehensive care — in service of our mission.

Read on to learn more about their backgrounds in the industry and join us in giving them a warm welcome!

Adam J. Fein, PhD, is the CEO of Drug Channels Institute, a leading source of industry research about pharmaceutical economics and the drug distribution system. Widely published in academic and industry publications, he also heads the Drug Channels website, praised by readers for its comprehensive and witty coverage of pharmacy benefit managers (PBMs), medication pricing, and other industry topics.

Delivering medications to our patients at the lowest price possible is central to our mission. Dr. Fein’s deep expertise in pharmacy economics supports our ongoing commitment to improve adherence rates by way of more affordable medication options and total price transparency.

“The pharmacy industry has entered a period of structural change. There’s a tremendous need for the cost transparency, efficiency, and commitment to patient well-being that Alto delivers. I’m thrilled to support Alto in building innovative solutions to foundational issues within the industry,” Dr. Fein said.

Dr. Fein holds a doctoral degree in managerial science and applied economics from the University of Pennsylvania’s Wharton School of Business.

Harry L. Leider, MD, MBA brings more than 25 years of experience as a senior healthcare executive to our board of advisors. Since 2018, he’s served as Chief Medical Officer and Executive Vice President of Gelesis, an innovative biopharmaceutical company.

In addition to his current leadership in the biotherapeutic space, Dr. Leider has broad experience in telemedicine, retail healthcare, laboratory medicine, and payor strategies, as former Chief Medical Officer of Walgreens Boots Alliance, Ameritox, and Care Improvement Plus.

Dr. Leider shares Alto’s commitment to driving lasting change within the healthcare system for better patient health. With both clinical expertise and executive experience, he’s spent his career designing programs, services, and intellectual property that improve health outcomes.

“Alto’s pharmacy model brings us closer to a future where everyone can receive the highest standard of care and is equipped to manage their health. I’m personally inspired by Alto’s bold vision for healthcare and look forward to what we can accomplish together,” Dr. Leider said.

Dr. Leider has served on the faculty of Harvard Medical School and the Johns Hopkins Carey School of Business and holds five patents in laboratory medicine.

Drawing on more than three decades of healthcare experience, Brad Fluegel is a strategic advisor to organizations, entrepreneurs, and other industry participants. Most recently he served as Senior Vice President and Chief Healthcare Commercial Market Development Officer for Walgreen Co, where he managed all commercial healthcare activities, from sales and contracting to biopharma relationships and market planning.

Previously, Brad oversaw Walgreens’ corporate strategy and business development as Chief Strategy and Business Development Officer. He also led Elevance (then Wellpoint)’s strategic planning and corporate communications as Executive Vice President and Chief Strategy and External Affairs Officer.

His expertise in strategic planning and operations will allow us to deliver an exceptional patient experience as we continue to grow.

“Since 2015, Alto has proven itself to be a leader in the rapidly evolving digital pharmacy space. It’s a privilege to support their efforts to redefine what’s possible in healthcare, and together we can deliver industry-leading care to more patients,” he said.

Brad earned a master’s degree in public policy from Harvard University’s Kennedy School of Government and a bachelor of arts in business administration from the University of Washington. He also serves as a lecturer at the Wharton School of Business.

Dr. Fein, Dr. Leider, and Brad join three other advisory board members: Dr. James Hildreth, the President and Chief Executive Officer of Meharry Medical College; Jennifer Kent, previously the Director for the California Department of Health Care Services; and Ajay Khatri, previously Alto’s Chief Strategy Officer. 

Dr. Hildreth, Jennifer, and Ajay have offered invaluable guidance as we’ve grown throughout the past two years, and we couldn’t be more grateful for their partnership and support.

Learn more about Dr. Hildreth and Jennifer’s healthcare experience.

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

Meet the Newest Members of Our Advisory Board

With many variables involved in an individual’s fertility, learning more about your reproductive health can help you manage expectations about your body’s response to fertility treatment. The anti-mullerian hormone (AMH) test, which measures your body’s levels of a hormone associated with ovarian reserve, is one potential source of information for those experiencing infertility.

AMH Testing in Fertility Treatment

While the AMH test can reveal certain factors related to your reproductive health, it is not relevant to all aspects of fertility, or all types of fertility issues. Here’s more about the AMH test, including what it can and can’t tell you.

Anti-mullerian hormone is a hormone that affects how a baby’s reproductive organs develop while in the womb. Male babies have higher levels of AMH than female babies.

AMH is also related to a woman’s ovarian reserve. Cells inside the ovarian follicles — fluid-filled sacs that release an egg during ovulation — produce AMH. An individual's levels of AMH correspond to their egg count, with higher levels of the hormone typically indicating a higher ovarian reserve.

Unlike many other hormones related to reproductive health, AMH levels remain steady throughout an individual’s menstrual cycle. This means that you can have your AMH levels measured at any time, unlike some other fertility-related blood tests.

An AMH test is a blood test that measures your levels of AMH, revealing the approximate number of eggs in your ovarian reserve that may be used for ovulation. It provides a snapshot into one aspect of your fertility, rather than a precise look at the whole picture.

The AMH test consists of a simple blood draw. It typically takes about a week for test results to arrive. There are at-home AMH tests available, however, it is important to discuss the results with a healthcare provider.

Below are general ranges of AMH levels, measured in nanograms per milliliter. Your provider can give you a clearer sense of what your AMH levels indicate.

An AMH test is an indication of the number of eggs remaining in your ovarian reserve. This is particularly relevant to in vitro fertilization (IVF), since one goal of IVF is to retrieve as many mature eggs for fertilization as possible. Your AMH test results may also inform your individual medication protocol for IVF, as they can help your provider anticipate your body’s response to ovarian stimulation medication.

The AMH test can also indicate the pace at which your ovaries are aging.

While AMH levels are helpful for determining egg quantity, they do not reveal anything about the quality of your eggs. Egg quantity factors into IVF success rates — the more eggs retrieved, the higher your chances are of producing multiple healthy embryos that may be placed into the uterus — but quality is also extremely important. It is possible to have a low ovarian reserve but a high percentage of viable eggs, in which case a successful IVF cycle would be more likely.

It is also possible to experience infertility despite having normal AMH levels. Other factors that may affect your ability to conceive include your age, lifestyle habits, ovulation disorders, uterine abnormalities, and endometriosis, among others. Sperm count and mobility also factor into a couple’s fertility. There are many diagnostic tests a reproductive specialist may use to evaluate your remaining egg supply and recommend the best treatment plan.

Read Infertility, Explained for a more comprehensive overview of common fertility issues.

A fertility pharmacy partner you can rely on

At Alto, we’re here for you at every step of your fertility journey. We offer free same-day delivery of your medications, with discreet packaging, fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists, and support with insurance and savings opportunities.

To learn more about how Alto can support your fertility treatment, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and is characterized by a hormone imbalance. It can impact many areas of a woman’s health, including menstrual cycles, fertility, insulin levels, and risk of cardiovascular disease.

How Polycystic Ovary Syndrome (PCOS) Affects Fertility

Symptoms of PCOS can be treated through a combination of medications and lifestyle changes. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Polycystic ovary syndrome has three defining symptoms: high levels of male hormones, irregular menstrual cycles, and the development of cysts in the ovaries. These features overlap.

Many women with PCOS have higher levels of androgen hormones, which are responsible for the development of certain male characteristics. For those with PCOS, overproduction of androgens leads to irregular menstrual cycles, hair loss, extra growth of hair on the face and body, and acne.

The cysts that develop in the ovaries are small follicles containing an immature egg. Since these eggs do not reach maturity, ovulation — the release of a mature egg from the ovaries — does not occur. The absence of ovulation leads to further imbalance of hormones, as progesterone decreases.

PCOS is the leading cause of female infertility.

Polycystic ovary syndrome can develop at any age after puberty. It is estimated that 5-10% of women between the ages of 15-44 have the condition.

The specific causes of PCOS have not been identified, but the medical community believes that condition is the result of several intersecting factors: insulin resistance, higher levels of androgens, higher levels of inflammation, and an irregular menstrual cycle.

Some evidence suggests that PCOS may have a genetic component. You may have a higher risk of developing PCOS if you have a mother, sister, or aunt with the condition. Obesity is also a risk factor.

Common symptoms of polycystic ovary syndrome include:

Irregular, absent, or abnormally short (i.e., less than 21 days) menstrual periods

Excess hair on the face, chin, chest, abdomen, or upper thighs, also referred to as hirsutism

Weight gain or difficulty maintaining a healthy weight

Patches of darkened skin, particularly on the neck, in the groin, and beneath the breasts

Small flaps of excess skin near the neck or armpits, sometimes referred to as skin tags

Infertility, defined as the inability to get pregnant after twelve months or more of unprotected sex

The hormone imbalances that characterize PCOS can affect many areas of a woman’s health, including the following.

Infertility is a common symptom of PCOS, as hormone levels interfere with ovulation, an important step in reproduction. However, PCOS is a highly treatable cause of infertility. Many individuals and couples affected by PCOS do become pregnant after fertility treatment.

During pregnancy, women with PCOS may face a greater risk for miscarriage, high blood pressure, and gestational diabetes. They are also more likely to deliver prematurely. If you have PCOS, you can set yourself up for a healthy pregnancy by maintaining a healthy weight and blood sugar levels before trying to conceive and during pregnancy.

Insulin is a hormone naturally produced in the pancreas. It helps convert sugar, or glucose, into energy. Type 2 diabetes occurs when blood sugar levels rise due to issues with the body’s production or use of insulin. Since insulin resistance is often a symptom of PCOS, many individuals with the condition have a greater risk for type 2 diabetes.

Individuals with PCOS are also more likely to develop metabolic syndrome, a group of conditions associated with a higher risk for diabetes and heart disease, including:

Abnormal cholesterol or triglyceride levels

Endometrial hyperplasia, a condition in which the lining of the uterus becomes too thick, is also associated with PCOS. It can increase a woman’s risk for endometrial cancer.

The process for diagnosing PCOS includes a conversation about your health history, a physical exam, and several tests that can rule out other causes of PCOS symptoms.

During the physical exam, a healthcare provider typically measures blood pressure, body mass index (BMI), and waist size. They will also check your skin for extra hair, acne, or discoloration.

Your doctor will likely conduct a pelvic exam to check for signs of high androgen levels and abnormalities with your ovaries. Then, a pelvic ultrasound, or sonogram, will check the ovaries for cysts and scan the uterine lining.

Blood tests may be used to measure levels of androgens as well as hormones linked to other health conditions with similar symptoms as PCOS. You may also be tested for high cholesterol and diabetes.

If other health conditions have been ruled out, you must have at least two of the following symptoms to be diagnosed with PCOS:

Irregular, absent, or abnormally short menstrual periods

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