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It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

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Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today. In this blog post we'll share an overview of the options as well as how Alto can help you in the path to parenting.

A Guide to LGBTQ+ Family Building

Assisted reproductive technology (ART) has expanded the paths to parenthood for all types of family structures. Whether exploring fertility as a single person, within a couple, or as a family unit, parenthood is now possible for more people than ever before.

A 2018 study found that 48% of LGBTQ+ millennials (aged 18-35) were actively planning to grow their families, compared to 55% of non-LGBTQ+ millennials. Researchers noted that this gap had narrowed significantly compared to older generations—the result of advances in technology and the movement for equality. 

Still, LGBTQ+ families confront unique challenges in an industry that often fails to center their needs. However, as more and more LGBTQ+ people seek to become parents through ART, the face of fertility is shifting. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today, including using a donor or surrogate for one or more components of biological conception (eggs, sperm, and uterus).

That being said, many options come with formidable costs so determining how to pay for treatment is an important part of planning. Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. If prescription fertility medications are part of your treatment, we’ll comb through the available discount and rebate programs to ensure you get the lowest possible price. 

To clarify which of the many paths-to-parenthood might be right for you, it can help to seek out an organization such as Family Equality Council that can provide specialized advice for LGBTQ+ families. It’s also essential to choose a clinic and doctor who can understand your needs and put you at ease. 

For LGBTQ+ couples exploring using a donor, it’s also essential to research the laws in your state regarding legal parentage procedures after your baby is born. For a starting point, you can learn about the laws in your area through Movement Advancement Project’s interactive ART law map; however, you should also speak with an experienced LGBTQ+ family lawyer in your state. 

Every budding family follows a unique path. It may include natural conception, adoption, foster care, or ART. For those considering the latter, here are some of the places your ART journey might take you. 

For those whose bodies cannot produce sperm or are experiencing infertility, a donor can be used. There are two ways to obtain donor sperm: from someone you know or from a sperm bank.

If you use a known donor—often a friend, family member, or other acquaintance—it’s crucial that you fully discuss the relational complexities involved and consult with a lawyer who specializes in working with LGBTQ+ families in your state. When choosing an unknown donor through a sperm bank, the donation’s legalities are less complex because the donor has already surrendered their parental rights. 

If you or your partner plan to carry the pregnancy, donor insemination is the process of placing the donated sperm inside the vagina or uterus to facilitate fertilization. There are two methods of insemination that may be used: 

Intrauterine insemination (IUI) is a simple medical procedure performed by a medical doctor where the sperm is placed directly into the uterus by using a very small tube passed up through the cervix.

With intravaginal insemination (IVI), the sperm is placed directly into the vagina. You can often perform IVI at home; however, many people choose to have a medical professional complete the insemination to increase the chances of success. 

Parents-to-be who were not born with ovaries or are experiencing infertility can use an egg donor. Like with sperm donors, an egg donor can be a known donor or be found through an agency. Again, when using a known donor, be sure to thoroughly discuss the arrangement’s details and consult with a lawyer who specializes in working with LGBTQ+ families in your state.

With both known and unknown egg donors, the egg must be fertilized in a lab and placed in a uterus through a medical procedure known as in vitro fertilization (IVF). 

Intended parents who cannot or will not be carrying the pregnancy for any reason can use a gestational carrier. The gestational carrier will have the embryos (eggs fertilized by sperm) transferred into their uterus, then carry and deliver the baby.

Choosing a gestational carrier is a critical decision that can take time. After all, your relationship will last the better part of a year. An agency can help you meet and screen candidates until you find the right match. 

IVF  is one of the most common fertility treatments. It involves combining an egg and sperm in a laboratory dish then transferring the resulting embryo into a uterus. IVF can be performed with donor sperm, donor eggs, or donor embryos. 

Reciprocal IVF, also known as co-maternity, is a specific instance of IVF where one partner provides the egg and the other carries the pregnancy. In this way, one partner is genetically related to the child while the other becomes biologically bonded through pregnancy. 

Egg or sperm freezing, also known as cryopreservation, is available to preserve future fertility for those looking to delay pregnancy or undergo gender affirmation treatment. Because gender affirmation treatment may affect fertility, it’s important to discuss the possibility of freezing your sperm or eggs with your doctor before undergoing treatment if you may want children who share your DNA in the future. For those currently undergoing Hormone Replacement Therapy (HRT), there may still be options available to preserve your fertility. Talk with your doctor about which choices may be right for you. 

There are many routes available to expand your family. Ultimately, every journey has the same destination in mind: the beautifully chaotic, utterly unique, yet completely universal journey of parenthood.

As you assemble a team you trust to guide your path forward, we’ll be here to support you if prescription medications become part of your plan. Our team of specialists has experience working with the LGBTQ+ community and receives training on how the nuances of the fertility experience may vary for each individual. We’d be happy to manage your medication needs so you can focus on your family during this life-changing time. Visit us at alto.com/fertility to learn more. 

Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

In this article, we’re going to focus on the where, why, and how of storing your insulin medication safely.

Taking Care of Your Insulin

For those living with type 1 diabetes and for many with type 2, taking insulin is a part of daily life. That’s because people with diabetes either do not produce insulin on their own or their bodies cannot use it effectively. For more on the role insulin plays in the body and essential facts about how it’s used as medication, we recommend reading, “Understanding Insulin: The Basics.” In this article, we’re going to focus on the where, why, and how of storing your insulin medication safely.

Insulin is one medication you can’t just toss into your medicine cabinet. That’s because insulin is a protein dissolved in water. Like any protein, your insulin can spoil if it isn’t kept cool. However, unlike the mystery food container at the back of your fridge, spoiled insulin won’t make you sick. The danger is that your medication may be rendered ineffective, causing your blood glucose levels to climb higher than you expect. 

For that reason, most of the storage guidelines detailed below revolve around temperature and expiration date. The bottom line: treat your insulin more like a perishable food item than your run-of-the-mill medicine stash. 

You should always store new or unopened insulin in the refrigerator (at a temperature between 36°F and 46°F). Take a peek at the expiration date listed on your medication and place it in your refrigerator as soon as you can. It’s important to discard your insulin once it reaches its expiration date, even if it is unopened.  

To ensure your insulin is not subject to temperature fluctuations in the refrigerator, getting a temperature sensor may be a good idea. Also, try to store your insulin on the center shelf—the area most consistent with the thermostat setting—rather than on the top shelf or door compartments.

Whenever you receive a new type of insulin, review the instructions for your specific prescription with your pharmacist. If you fill your prescription with Alto, you can check your medication’s details and instructions at any time in the Alto app or your online account. Plus, our care team is always an in-app chat or call away.

Since injecting cold insulin can be uncomfortable, it’s okay to keep the open vial, cartridge, or pen you are currently using at room temperature (between 56°F and 80°F) for about a month. 

In general, you will need to discard your insulin 28 days after opening it, but be sure to check the information provided with your specific medication or reach out to your pharmacist to confirm. Label your vial, cartridge, or pen with the date you first open it so you’ll have no problem remembering when it’s time to throw it away. 

Always check both the original expiration date listed on your medication and the date of opening before every use. Do not use expired insulin. You should also inspect your insulin before every use, looking for any changes in color or clarity as well as any crystals or clumps. If you notice changes or have any doubts, use a new vial, cartridge, or pen. 

While you’re on the move, it’s still essential to keep your insulin from getting too hot or too cold. You want your insulin to remain between 36°F and  80°F. Keep in mind, even if the temperature outside isn’t extreme, your insulin can quickly heat up if left in a parked car or intense sun.  

If your insulin has been frozen or exposed to extreme heat, you should not use it—even if it has cooled back down or thawed. There’s a high probability that your insulin will be ineffective, and a blood sugar spike could catch you off guard. 

Carry your insulin with you in an insulated bag (remember—treat it like perishable food) and keep all your medication supplies in your carry-on if you’re traveling by plane, train, or bus. It’s always a good idea to make sure your prescription label is visible, especially if you’ll be going through airport security.

No one wants to stand in line at the pharmacy month after month. But insulin’s temperature sensitivity doesn’t lend itself well to being shipped through the mail—you don’t want it spending hours sitting on your doorstep or the back of a mail truck.

When you choose Alto for your prescriptions, we’ll deliver your insulin by hand using temperature-controlled packaging. You can choose a delivery window when you know you’ll be available to receive your package and place it in the refrigerator right away. We’ll monitor your medication’s temperature as it makes its way to you, and you can track our progress the whole way. Best of all, our delivery service is completely free. 

We’re here to make managing your insulin prescription easy. Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

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

In honor of National Diabetes Month, here are seven ways we can take action together to spread the word about diabetes prevention.

Take Action in Honor of National Diabetes Month

November is National Diabetes Month — a time to raise awareness about the increasingly widespread diabetes epidemic in the U.S. It’s also a chance to come together and take action, not just for the one in ten Americans who have diabetes, but for the more than 88 million adults — 1 in 3 — who are at high risk of developing type 2 diabetes due to high blood sugar levels (a condition known as prediabetes).

More than 84% of all those living with prediabetes don’t know that they have it, partially because there often aren’t any noticeable symptoms. And while people ages 45 and older are most at risk of developing prediabetes, the condition has become more prevalent in young people in recent years, as childhood obesity — a condition linked to diabetes — remains an urgent health issue in the U.S.

The good news is that simple lifestyle changes can prevent prediabetes from progressing into type 2 diabetes, and possibly even reverse prediabetes. So this November, join us in honoring National Diabetes Month by taking small steps to prioritize your health and raise awareness of diabetes prevention. You can start with the seven actions below.

Both type 1 and type 2 diabetes — the two main types of diabetes —  involve complications with the body’s relationship to insulin, a hormone that transforms a simple sugar called glucose into energy. However, there are some important distinctions between the two conditions.

Type 1 is an autoimmune disease in which the body mistakenly destroys the pancreas’s insulin-producing cells. It often begins during childhood or adolescence, though a diagnosis may occur at any age.

In contrast, type 2 diabetes — the type of diabetes that people with prediabetes are at risk of developing — progresses gradually over time due to a mixture of genetic, lifestyle, and environmental factors.

National Diabetes Month is an opportunity to educate yourself and others about the different types of diabetes. As a starting point, read our blog post, ‘What’s the Difference between Type 1 and Type 2 Diabetes?’

(There is also a third type of diabetes — gestational diabetes — diagnosed during pregnancy, which you can learn more about here.)

Don’t be afraid to learn about your risk for prediabetes — knowing where you stand will allow you to take control of your health. The CDC-led National Diabetes Prevention Program offers a free risk test and other helpful resources at doihaveprediabetes.org. If you determine that you’re at risk, talk to your doctor so you can assess your risk level and develop a prevention strategy together. 

Consider sharing this tool with your loved ones or even via your social media channels, too — raising awareness is the best way to turn the tide on diabetes. 

Broader healthcare inequities drive racial and economic disparities in prediabetes and diabetes, which disproportionately impact individuals from underserved communities. According to the American Diabetes Association (ADA), Black Americans are 60% more likely to receive a diabetes diagnosis.

If you feel inspired to make waves for change, contact your government representatives to advocate for affordable and accessible healthcare for everyone. The ADA has created this online resource to help you reach out to lawmakers in your area and ask them to support legislation designed to end health disparities, from expanding health insurance coverage to making insulin more affordable. You can also sign up as an ADA Advocate to stay informed about issues affecting people with diabetes. 

If you or someone you know has type 1 diabetes, you might also consider signing up to become an advocate for JDRF,a nonprofit that funds research and advocates for policies to help people with type 1 diabetes (T1D). According to JDRF, “Advocates use the most powerful tools they have — their own personal stories — to communicate the financial, medical, and emotional costs of T1D to our nation's leaders.” 

From enlightening talks to a live cooking class, the ADA is hosting some amazing virtual events throughout National Diabetes Month. Ask questions, listen to inspiring stories, and learn tips that can help you live a healthier life. 

You’ll also find a slew of virtual events hosted by JDRF on their monthly calendar, including a holiday auction, various meet and greets, and a Q&A session with an endocrinologist. 

Anyone can benefit from healthy choices, regardless of their risk for diabetes. This is a great opportunity to work on a new habit throughout the month. Whether you decide to take a daily walk or experiment with healthy kitchen swaps like chickpea pasta or nut-based milk, pick an activity that you actually enjoy and try your best to keep it going. 

The jury is still out on how long it takes to solidify a new habit, but one recent study found that it took an average of 66 days before participants felt that new habits like eating fruit at lunch or running for 15 minutes became automatic. Of course, the actual time will vary by person and the perceived effort of the new activity, but the study found that daily repetition during the first few weeks was the key to making the new habits stick. 

If you’re currently living with diabetes, use this month as an annual reminder to recommit to your treatment plan. Taking medications as prescribed and keeping up a healthy lifestyle, including proper nutrition and exercise, is an essential part of reducing the impact of diabetes on your long-term health and well-being.

You may want to consider working with a certified diabetes educator. These healthcare professionals have extensive knowledge of diabetes and have been certified to coach individuals living with the condition. Their expertise spans nearly all aspects of diabetes management, from navigating insurance, connecting with support programs, and managing daily life with diabetes.

Read our previous post, ‘What Does a Diabetes Educator Do and How Can They Help You?’ to learn how a diabetes educator can support your diabetes management plan. 

"When I refer patients to Alto, it's one thing they don't have to worry about."

And if you’re among the 1.5 million people who were newly diagnosed with diabetes this year, we share some helpful tips for settling into your routine in “Managing Your New Diabetes Diagnosis.” 

7. Find the best pharmacy for your diabetes care

Managing your monthly medications should never be a struggle. Our pharmacists are on call to field medication queries and walk you through doses or injections. We can deliver whatever you need — including insulin, glucose monitors, test strips, and more — directly to your door for free. For more on how we can help, read “The Best Pharmacy for Diabetes Care.” 

Want to learn more about Alto? Reach out any time through in-app secure messaging or by phone at 1-800-874-5881..

Editor’s Note: This post was originally published in November 2020 and has been updated for accuracy and completeness.

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world.

Celebrating National Pharmacist Month at Alto

Every year, we look forward to October, when we get a whole month to honor the extraordinary work of the pharmacists and pharmacy technicians at Alto and around the world. National Pharmacist Month is a time to celebrate the many ways that pharmacy professionals positively impact their communities. At Alto, we get an intimate look at how pharmacists improve the health and well-being of others every single day through their expertise and exceptional care.

This year’s theme is “Essential Providers, Accessible Care,” recognizing the vital roles that pharmacists and pharmacy technicians are playing on the front lines of healthcare during the COVID-19 pandemic. From the common cold to chronic disease, pharmacists are always there to answer important health questions and make sure medications are not only accessible but used safely and effectively.

National Pharmacist Month is a great time to show your appreciation for the pharmacy professionals who help with your medications. It’s also an opportunity to learn more about the depth of their expertise. For example, did you know that becoming a pharmacist requires a doctorate degree? Pharmacists are not only experts on medication management, they also serve as patient educators, perform laboratory studies and health screenings, and act as skillful problem solvers. Whether we’re facing an acute issue or a chronic condition, many of us turn to our pharmacists to suggest supplements, over-the-counter medicines, or lifestyle adjustments that can help us feel better. 

In addition to our month-long celebration of pharmacy professionals, the third Tuesday of October has its own special designation: National Pharmacy Technician Day. On this day, we recognize the unique and invaluable contributions of pharmacy technicians. A critical part of any healthcare team, pharmacy technicians work closely with pharmacists to make sure patients get the medications they need. Technicians not only assist in the preparation and distribution of medications, but they also work directly with community members to collect patient information and help process billing claims.

Both pharmacists and pharmacy technicians are essential in providing us with access to safe and effective treatment when health issues arise. This year, more than ever, we are grateful for their steadfast dedication to your care. 

In honor of the 116 incredible men and women who perform these vital roles at Alto, here are five facts you may not know about the pharmacy profession:

October 12th is Women Pharmacists Day! About 55% of pharmacists are women, making pharmacy a predominantly female field. 

Pharmacists are the most frequently visited healthcare providers in America. They can be found working in a variety of settings—from hospitals to the neighborhood pharmacy—and we turn to them most often for health advice. 

The world’s oldest prescriptions were etched into tablets around 2100 B.C

Benjamin Franklin is considered one of the founding fathers of pharmacy. He helped to establish the first public hospital and hospital pharmacy in the United States. 

Agatha Christie, the crime novelist, worked as an apothecary’s assistant, or what we would now call a pharmacy technician. Her interest in medicine was apparent in much of her writing, inspiring her many plot lines about poisoning and disease. 

We at Alto could not be more proud of our incredible pharmacists and pharmacy technicians. Through your skills as educators and guides, you uplift the health and well-being of the communities you serve. 

Want to express your gratitude to the pharmacists at Alto? You can reach out by phone or through the app to say thanks and brighten their day. 

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Airbnb’s Former Head of Business Technology Joins Alto

In July 2020, Catherine Scott joined Alto as Head of IT, responsible for building and leading a high performing IT team. Previously, Cat spent five years at AirBnB where she acted as the Global Head of Business Technology during their worldwide growth and was pivotal in delivering exceptional technology experiences to employees. With this expertise, and over 20 years experience spanning startups to Fortune 500 Companies, we are excited to officially call her an Altoid! 

We sat down with Scott to learn more about her plan to build Alto’s IT strategy and support teams focused on End-User Support, Infrastructure & Networks and Business Applications. 

Welcome to Alto! What excites you most about recently joining the team? 

Thank you! I’ll start by sharing that I am excited by companies that have a strong mission. This was an important consideration for joining Airbnb.  When contemplating what was next, I knew that this was a primary driver for my next move.  Alto’s mission - to improve the quality of life for everyone - very much resonated with me. 

Aside from that, my conversations with Altoids during the hiring process reflected a sense of passion and humility that I found to be rare in a successful company. There is a culture of really intelligent, driven individuals here that are unpretentious about their accomplishments. 

Likewise, any time I evaluate an opportunity for growth, I assess the impact that I can have based on my experience. Given my background in consulting, startups, and Fortune 500 companies, I found Alto’s goals to be in line with my ability to improve efficiency and help IT mature into being viewed as a critical enabler to our business.

You were the Global Head of Business Technology (Products) at Airbnb for 5 years. How did this experience shape your outlook on strategic growth and what was the most important lesson that you learned? 

When I joined Airbnb the IT organization was in its infancy. We were present in 192 countries and yet there were only six people assigned to the global team.  It was imperative to create a global strategy quickly that would both enable the hyper-growth of the company and consider how to scale in a cost effective way.

I think the key takeaway is that IT is everywhere. It's a foundational layer supporting how everything functions. Thinking about IT early in a company’s lifecycle is essential, but above that you have to ensure everything is thought of from a scalable perspective. If we only build for right now there will inevitably be a technical rework later so making sure the IT services are both built for increased volume and still cost effective is important.

Can you share a little bit about your goals at Alto for the remainder of the year? 

Right now I’m very focused on what I would call core/foundational IT (network infrastructure, IT support function, etc.) -- essentially the programs that are the enablers for everyone. I’m also working closely with Alto’s Director of Security to ensure that we continue to protect our patients' data with the utmost level of reliability. 

Next year I’d love to start addressing  how IT can enable more business return on investment. For example, managing and implementing 3rd party applications. Typically, and this was the same at Airbnb, if everyone is going off and buying different, potentially duplicative, applications, we start to leave money on the table and can have disjointed data and compromise security. This is where IT starts to become a case for ROI and business benefit. 

I’ll actually contend that Alto is a forward thinking in recognizing the importance of IT. Because of this, I know I’ll be able to create positive benefits because we’ll be in front of the curve. At the end of the day, if we can grow in a thoughtful manner, we’ll arrive at a place where we’ll have a really high performing IT organization that contributes to the bottom line. 

You know, my motto is to “embrace the adventure.” I love spending time outdoors, whether hiking, skiing, or sailing, so it really resonates in my professional life as well. I feel excited about developing an IT strategy that will ensure high quality services both in our sites and remotely, protect our internal data, maximize productivity of our workforce, and ultimately contribute to the company mission of improving the quality of life for everyone.

The good news is, having done this before, I don’t think there’s anything that’s a surprise yet. During the interview process, I knew that this role would require another ground-up build and that it would require a strategic and thoughtful leader. Having said that, the results are always less about me and more about what the team has been able to do and how we have contributed to Alto’s success.

On that note, how would your prior teams describe you? 

I think, or hope, my team would say that I’m incredibly supportive in removing anything that is keeping them from being able to achieve maximum impact or create maximum value for the company. I define myself as authentic, trustworthy and driven -- and value those qualities in others. I definitely have a high bar for excellence and want my team to be successful at performing but at the same time, I’m also there to help when needed and support their professional development. 

Stylistically I’ve always been a leader where I kind of exist to support others and provide thought leadership. You are nothing without your team. To quote Steve Jobs, "It doesn't make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do." This philosophy is one that has always resonated with me. 

How do you feel about technology changing our work culture given the current climate of COVID-19? 

Alto is the first job where I joined having never met a single team member in person. It’s definitely changed things up but I’m pretty comfortable with it at this point. Looking forward though, I think it’s important to consider how we can recreate the “magic” that happens in person when a number of our workforce is remote. 

COVID highlighted the significance of innovative IT related to remote work and collaboration that is essential for everyone. That area of creativity is where I think IT will fundamentally shift how we continue to work and communicate with one another in what may be an increasingly remote workforce. 

Are you working on any passion projects outside of Alto at the moment? 

Yes! I’m very passionate about animals and am currently looking to rescue another dog. Aside from that, I’m recently new to the Tahoe, CA, area so hope to become more embedded in community volunteering. 

My other personal passion project is actually an overhaul remodel on our Tahoe house which has required a fair amount of architecture and engineering for my husband and myself. It’s a fun project that keeps us constantly engaged with one another. 

What would you say to someone interested in joining the Alto team, specifically in a technology driven role? 

Just do it, it’s an amazing opportunity! I believe so strongly in what Alto is doing. If you ever have an opportunity to work for a company that is founder-led you should make it happen. There is a palpable passion that resonates throughout a company when the founders are present. It’s an experience worth doing because it creates a belief and excitement around the company that might not happen otherwise. 

For more information on Scott, or to connect with her directly, reach out via LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers. 

Airbnb’s Former Head of Business Technology Joins Alto 

In this article we’ll share what a typical IVF schedule might look like, beginning with medications used to grow follicles, the egg retrieval process, and finally, transfer options.

IVF Medications: Schedule and Side Effects Explained | Alto Pharmacy

IVF, or in vitro fertilization, is one form of treatment that may help those experiencing infertility to conceive. In fact, at least 8 million babies born today are a result of this procedure. That’s remarkable when you consider the first successful IVF procedure was only conducted in 1978.  

In this article we’ll share what a typical IVF schedule might look like, beginning with medications used to grow follicles, the egg retrieval process, and finally, transfer options. Let’s take a closer look at how one might arrive at each step. 

What Medications Should I Expect with IVF? 

The IVF process itself requires considerable IVF medication use on a precisely timed schedule. For these reasons, it’s important to understand what you might be prescribed as well as any potential IVF medication side effects. 

On the first day of a patient’s menstrual cycle they will typically call to schedule a “baseline” visit for Day 3 of their cycle. This appointment includes an ultrasound and bloodwork. After this visit, if approved, patients will start hormone injections (commonly referred to as “stimulation meds” or “stims”). 

These injections stimulate egg production so a woman’s body produces many follicles in a cycle, not just one (follicles house eggs that contain all the hormones and fluids needed to make an egg mature). Patients with one or more follicles already grown may need to wait until their next period cycle or use a different protocol. 

Stims are typically injected between 6-9PM daily at a consistent time. 

Supportive/adjunctive medications include: 

Omnitrope® -  A growth hormone whose main purpose is to help improve the quality of eggs. Not every patient will see this on their protocol. Typical use cases include poor responders to stimulation medications and women who have a decreased ovarian reserve.

As a result of injections it is normal for patients to experience soreness or mild bruising at the site of injection. Bloating, cramping, headaches, breast tenderness and in some cases, temporary allergic reactions are also common side effects. 

During this period patients will continue stims and may start what is known as “antagonists” to prevent premature ovulation (i.e. once eggs are released into the pelvic cavity they cannot be retrieved). These types of medications block the hormone (gonadotropin-releasing hormone-GnRH) that causes eggs to be released from the ovaries. 

Regular monitoring visits will likely include additional ultrasounds and bloodwork and occur around days four and six and every other day after. Visit results will then determine if nightly doses need to be changed or if an antagonist is necessary. In these cases, patients will often have leftover medications or need refills. 

Side effects are similar to those experienced during days one to four. Some patients also experience what is known as ovarian hyperstimulation syndrome (OHS). In this instance there is an overproduction of follicles that can cause extreme swelling or pain in the ovaries. Depending upon the severity, treatment may be cancelled until a future cycle. 

Patients will receive a final ultrasound and bloodwork to confirm if the follicle pack has reached maturity. If so, a “trigger shot” is assigned approximately 35-36 hours before retrieval to stimulate final growth spurt and ovulation. 

Trigger shots are hormones that support the normal development of an egg in a woman's ovary, essentially triggering the egg to go through a final growth spurt, and stimulate the release of the egg during ovulation from the follicles within 36 hours. 

In most cases, patients will discontinue all other medications and are given a deep sedation for the 15-45 minute retrieval process. Following the procedure it’s normal to feel mild cramping or experience some vaginal spotting. 

Keep in mind that follicles may be empty at the time of retrieval or contain an immature egg. This means the number of eggs retrieved after egg retrieval may be lower than the number of follicles seen on the ultrasound or based on bloodwork.

Sperm is collected according to clinic protocol or donor sperm is thawed at the time of egg retrieval.

The retrieved eggs and sperm are combined and monitored for signs of fertilization as the embryo(s) divides into a small cluster of cells.

The quality of embryos are given a grade, often using a common A-D rubric with A = excellent quality, D = poor quality to determine the likelihood of a successful implantation.

“Fresh” transfer: For patients who are seeking to transfer their eggs immediately after retrieval, the embryo can be transferred in 2 different stages of its lifecycle:

1) They can be transferred on approximately day 2 or 3 after fertilization when it is in its cleavage stage.

2) They can be transferred between days 5-7 after fertilization when it is in its blastocyst stage.

The best appearing embryos are then deposited into the uterine cavity using a catheter. Patients may experience cramping, bloating and spotting following this procedure. 

“Frozen” transfer:  In some scenarios for egg freezing, i.e. planning for the future, the embryos are not transferred immediately. In this instance, because the technology does not currently exist to keep an embryo viable outside of the womb for an extended amount of time, embryos are frozen through a process called vitrification. 

After transfer (0-1 days post retrieval), progesterone supplements provide hormonal support for successful attachment of the embryo to the uterine lining using vaginal, oral, or injectable progesterone and in some cases, a combination of methods. Common medications include: 

Progesterone capsules, suppositories, lozenges

And finally - within 12 days to two weeks a blood sample is taken to determine if the transfer resulted in a successful pregnancy. This test measures the hCG (human chorionic gonadotropin) levels, often referred to as the “pregnancy hormone,” which indicates cells are forming in the placenta to nourish the fertilized egg.

Despite how involved IVF medications might be, know that you are not alone in this journey. Alto’s dedicated fertility pharmacists are here to help answer your questions and work with your physician to ensure your IVF treatment plan is followed properly. To learn more visit us at alto.com/fertility or reach out any time through in-app secure messaging or by phone at 1-800-874-5881. We’re here for you from your first cycle to your last and everything in between. 

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

IVF Medications: Schedule and Side Effects Explained

If you’ve been stuck in a cycle of wired nights and exhausted days, your body and mind need help remembering how to relax. These strategies can help you break free from unhealthy sleep patterns and finally get some solid shut-eye. 

Too stressed to sleep? These strategies can help.

Stress and sleep can form a pretty vicious cycle. No matter how physically exhausted we feel when our heads hit the pillow, we just can’t seem to quiet our racing minds. Then, after tossing and turning our way through the night, we’re way too fatigued to function at our best. This leads to more anxiety...and on and on and on. 

Stressors like anxiety and worry send our bodies into “fight or flight” mode. Normally, this state of hyperarousal fades away once the threat is gone. But chronic stress causes our nervous system to continually work on overdrive, pumping out hormones that keep us revved up and alert even when it’s time to sleep. 

In the world of mindfulness, we hear a lot about “present moment awareness.” That’s because it’s the one place your stress doesn’t live. If you’re anxious about something, you’re either fixating on a past scenario or worrying about a future event. You’re so stuck looking forward or backward that you can barely focus on the task at hand. The practice of mindfulness is meant to break these toxic thought patterns by helping you become aware of when you’ve drifted from the present moment. In this way, it can actually stop stress in its tracks. 

Try listening to a guided mindfulness meditation as you transition out of “work mode” in the evening or while lying in bed if you can’t sleep. The Insight Timer app is a fantastic resource for free meditations, or try Calm, one of the most popular apps for meditation and sleep. If your employer offers access to Modern Health you might also try their “Body Scan for Sleep” in-app meditation.

Remember—you can’t change the past or control the future, no matter how many times you turn a situation over in your mind. Your best bet is to try to live where your stress cannot. 

If you often find yourself dreaming about a stressful project or jolting awake with a worrisome thought, a simple journaling practice can help. If your mind is swirling with worries as you fall asleep, you could be carrying that mental load into your dream state. Before you go to sleep, spend some time writing out whatever is on your mind. List out items on your to-do list and journal about any anxieties from your day. The simple act of writing it down will signal to your brain that it’s okay to let it go. That way, your brain can go about its nightly tasks and leave you to sleep in peace.  

According to the American Psychological Association, the body tenses up during a stressful event as a way of protecting us from pain or injury. With chronic stress, however, our muscles never drop their guard and remain continuously tightened. If you’ve ever woken up stiff and groggy after a full night’s sleep, your tense muscles could be the culprit. Try gently encouraging them to relax with a simple nightly body scan. 

Focus your attention on an area of your body and mentally tell it to soften and relax. Begin with the area behind your eyes, followed by your jaw, your neck, and each of your shoulders. Continue like that, relaxing one area of your body at a time. You may find you drift off effortlessly before you’ve made it all the way through. 

It’s important to set up a relaxing atmosphere that will prime your body and mind for deep sleep. Turn off your electronics and keep the lights dim as you get ready for bed. If you sleep near a window, make sure that your curtains are drawn to shield you from any outside light or simply hang a blanket or sheet. The National Sleep Foundation recommends keeping the room temperature between 60 and 67 degrees Fahrenheit for the most sleep-conducive environment. 

If you’re in a busy house or area, white noise or ambient music can help mask any disturbances. The Relax Melodies app lets you create your own unique mix of relaxing music and sound, and the Slumber app has a whole library of sleep-inducing stories and soundscapes. Lastly, if you really want to set the mood for sleep, try a diffuser or pillow mist with relaxing essential oils such as lavender or chamomile. Details like these will be especially helpful as you adjust to the time change at Daylight Savings Time. When your mind associates your bedroom with the feeling of being drowsy, you can hit the pillow a little earlier throughout the week and still easily fall asleep. 

Stress can be tricky, so you may need to experiment a bit to find what works for you. If you just can’t seem to break the cycle and a lack of sleep is negatively impacting your mental health, talk to your doctor. There are therapies and medications that can help with insomnia and other sleep disorders. If your doctor does recommend a prescription sleep aid, we’ll be here to help. Let our team take care of the details while you focus on rest.

Ready to take the stress out of your prescriptions? Our team is available to answer your questions through in-app secure messaging or phone.

Too Stressed to Sleep? These Strategies Can Help. 

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! Here they share their learnings, accomplishments, and their advice for future Alto interns.

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

Erik Gregorio Cruz, Micaela Moss, and Jordane Thomas joined Alto this summer as the company’s first engineering interns! In their three months with us they blazed the trail for future Alto interns while adjusting to a new norm of fully remote work during the global pandemic. Here they share their learnings, accomplishments, and advice for future Alto interns.

Coming out of a bootcamp program rather than a traditional Computer Science degree program, Micaela hoped to find a company open to non-traditional educational paths. “I know that a company that is welcoming of bootcamp grads values diversity, inclusivity, and mentorship.” 

For Erik, it came down to his interview experience: “Everyone seemed to really enjoy their experience and really believed in the mission they were working on.” Micaela agreed, adding that it also ultimately came down to the people for her. “You can tell a lot about a company’s culture based on what the people who interview you are like,” she said. “From the recruiter to the engineers, everyone was incredibly friendly and a joy to interact with.”

What was the most fun moment of your internship? (That is, assuming you had fun!)

Virtual team lunches were a highlight for all 3 interns. However, one special moment during Micaela’s internship actually came from resolving a ticket that involved writing an end-to-end (E2E) test—something she was not looking forward to. “I was dreading it for two reasons: First, I do not particularly enjoy writing tests—I’d rather write the code that passes them—and second, I had never worked with Cypress before. Several hours later, after reading lots of documentation, studying previously written E2E tests, and getting stumped by a hidden selector, I managed to write the test. When I finally ran it and got to watch the video as it clicked on buttons and filled out inputs, I became instantly enchanted. I may have run it several more times just to watch it, smiling like a goofball, knowing that this test that I had created would be run every time code was pushed and merged.” 

In addition to their respective engineering managers, whom the interns had weekly 1:1s with, each intern was also assigned a dedicated mentor, who committed at least 5 hours a week of dedicated support to their interns over Slack and Zoom. Mentors were able to provide historical and business context, help interns get ramped up on Alto’s tech stack, codebase, and tools, and pair program as needed. “Working with my mentor definitely made me more productive,” said Jordane.

The mentors added that working with the interns actually helped them improve their ability to articulate technical concepts, as well as their ability to talk through technical challenges with others more effectively in their day to day work.

What was it like interning during the pandemic and being fully remote?

“I found myself setting up ‘Hey, there’s a pandemic, and this is crazy, so let’s get introduced virtually, maybe?’ meetings,” said Micaela. “Although, as someone who is horrible with names, it is worth noting that a silver lining to being entirely remote is having everyone’s name in the corner of their zoom video. That, and sweatpants everyday!” 

Erik and Jordane agreed that being remote required a little extra effort. Alto’s engineering office is based in SF, and since they weren’t required to be physically in-office this summer due to the pandemic, both Erik and Jordane were based in other time zones. “In the beginning I was starting my day at 9am EST/6am PST, but if I got stuck I would have to wait until West Coast working hours before I could reach out,” explained Jordane. With time, “I picked up a different working rhythm that worked better for everyone.”

While Jordane was surprised by just “how friendly and accessible everyone was,” Erik was surprised by how quickly he was able to actually deploy code. 

Acknowledging that her chosen career path has a history of gender imbalance, Micaela shared that she “was pleasantly surprised” to have both a female manager and a female mentor. “It was a great experience getting to have two strong female role models to learn from during my internship.”

Micaela and Jordane were both on the Pharmacy Platform team, which defines best practices and processes that promote a future-forward and scalable way of development. The platform team provides tools, libraries, and services that make development work at Alto and enable all of Alto's engineers to write performant code. Erik was on the Pharmacy Supply Chain team, which enables a better, faster experience for patients by ensuring the right medications get out the door, on time, and at the lowest cost possible.

Erik’s mentor, Eric Leite, helped us understand what Erik contributed to the Pharmacy Supply Chain team: “Sometimes our operations workflow requires manual intervention to resolve issues. We use an extendable admin interface to help us navigate the more complex issues. Erik created an add-on to this application that helped our on-call team work more efficiently. We can now resolve a specific kind of complex insurance claim issue by using his add-on to guide us through the multi-day resolution process. Erik learned about our supply chain operations workflow, how insurance claims are processed, how to model out a problem using Ruby on Rails, and how to write effective tests using RSpec.”

Micaela and Jordane, both on the Pharmacy Platform team, worked on optimizing performance and cleaning up legacy code. For instance, Jordane helped standardize Alto’s frontend by increasing adoption of our component library. “Although this was a relatively straight-forward task that didn’t require much problem solving, it did require a lot of endurance,” said Jordane. “I had to edit and test changes to over 300 files by hand. There were many times I could have broken [the platform], and changes needed to be made very carefully.”

What is the biggest learning you are taking away from this experience?

“The biggest learning I am taking away from this experience is nicely summed up by the grail knight in Indiana Jones and the Last Crusade: ‘You have chosen...wisely.’” said Micaela. “I knew I enjoyed software engineering when I was learning it, or when I was working on my personal projects, but that can change when it becomes a job. After spending the summer as a software engineering intern at Alto, I can say with confidence that I have chosen...wisely.”

Jordane discovered that “engineering isn’t just innovation,” as he came into the experience believing; “it’s also investigation.” When we asked the interns’ mentors and managers what they had learned from the interns, they all recognized the genuine curiosity the interns brought into their respective teams and projects, which helped them to see Alto’s codebase through new eyes. They also gushed about the excitement the interns had when pushing to production for the first time.

What words of wisdom would you give to future Alto interns?

All three agreed: ask as many questions as you need to! “Over communicate, and just relax & enjoy the process!” offered Jordane. Erik agreed sharing, “Do not be afraid to reach out when you get stuck. Reaching out for help is essential.” 

“An internship is all about learning and growing,” said Micaela, “so take advantage of the wisdom and experience of your peers. They have a lot to offer!”

Ashley Qian, the Senior Engineer who mentored Micaela, advised, “Know your limits! Take breaks! Find something else to enjoy other than software engineering because your work is not your life, and your life is not work. Surround yourself with people who are your advocates and go to bat for you, and if you find yourself in a system or an environment that does not support you, try to understand what your boundaries are, and leave if you can. You always have a shoulder to lean on if that's the case, here, with the friends you've made at Alto!

Interested in being an intern at Alto? Check out our careers page HERE.

When trying to understand the (rather large) differences between type 1 and type 2 diabetes, we find that it’s helpful to start with what they have in common—namely, a problem related to the hormone insulin. 

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Taking Care of Your Insulin

Take Action in Honor of National Diabetes Month

Celebrating National Pharmacist Month at Alto

Airbnb’s Former Head of Business Technology Joins Alto

IVF Medications: Schedule and Side Effects Explained

Too Stressed to Sleep? These Strategies Can Help.

How to Make the Most of Your Engineering Internship — Advice From Alto's First Interns

What’s the Difference between Type 1 and Type 2 Diabetes?

Tips for Navigating Birth Control Costs

Alto’s Denver Team is Delivering Impact During the COVID-19 Pandemic

Are You Right for Alto?

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