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About 9% of men and 11% of women in the U.S. have faced fertility issues. These challenges may feel overwhelming, but there are a variety of treatment options for both male and female infertility to support your family building journey.

Here’s an overview of the causes and symptoms of male and female infertility and common fertility treatments.

Infertility, Explained

About 9% of men and 11% of women in the U.S. have faced fertility issues. These challenges may feel overwhelming, but there are a variety of treatment options for both male and female infertility to support your family building journey.

Here’s an overview of the causes and symptoms of male and female infertility and common fertility treatments.

Infertility, defined as the inability to get pregnant after twelve months or more of unprotected sex, is a health condition that affects both men and women. Approximately one-third of infertility cases stem from a female reproductive factor, one-third stem from a male reproductive factor, and one-third stem from a combination of both or unknown causes.

These are some common causes of female infertility.

The majority of female infertility cases are caused by problems with ovulation, the release of a mature egg from the ovaries. There are several causes of ovulation disorders, including the following.

Polycystic ovary syndrome (PCOS), a condition characterized by a hormone imbalance that impacts ovulation. It is the leading cause of female infertility.

Excessive exercise, eating disorders, or stress, each of which can result in hormonal imbalances

Primary ovarian insufficiency, sometimes referred to as premature ovarian failure

Fallopian tube damage or blockage can prevent sperm from reaching an egg, or fertilized eggs from attaching to the uterus. Common causes of fallopian tube damage or blockage include pelvic inflammatory disease — an infection of the uterus and fallopian tubes from chlamydia, gonorrhea, or other sexually transmitted infections — or a prior surgery in the abdomen or pelvis, including surgery for ectopic pregnancy.

Uterine or cervical issues such as the following can disrupt the implantation of an egg into the uterus or increase a woman’s risk for miscarriage.

Benign polyps or fibroids may block fallopian tubes or interfere with the implantation of an embryo. However, many women with these growths are able to conceive.

Structural issues with the uterus that are present at birth

Cervical stenosis, a narrowing of the cervix

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows elsewhere. The abnormal tissue growth — as well as surgical procedures to remove it — can block the fallopian tubes, preventing the fertilization of an egg. In some cases, endometriosis may interfere with implantation of the fertilized egg, or embryo.

Male infertility is most often an issue of sperm production — including the quantity and quality of sperm produced — or of sperm mobility, which affects the sperm’s ability to find and fertilize an egg. A blockage in the testicle or damage to the reproductive organs can also contribute to male infertility.

Age is a factor in both male and female fertility issues. The quality and quantity of a woman’s eggs begin to decline as she enters her mid-thirties, and age factors into the success rates of in vitro fertilization (IVF).

Many individuals and couples first learn of a fertility issue after trying to conceive without success, and the primary symptom of infertility is the inability to get pregnant. There aren’t always noticeable symptoms, but the following may indicate an underlying fertility problem.

A menstrual cycle that’s irregular, absent, longer than 35 days, or less than 21 days

Unusually light or heavy bleeding during menstrual cycles

Erectile dysfunction or low sex drive in men

The timeline for seeking fertility treatment depends on your age. If you are under the age of 35, most health experts suggest consulting a reproductive specialist after a year of trying to conceive. If you are between 35 and 40, you may want to pursue testing or treatment after six months of trying to become pregnant. And if you are over 40, you may want to pursue testing or treatment before you start trying to conceive.

An evaluation for fertility issues and potential treatment begins with a conversation about your health history. Several tests may be used during the diagnostic process, including the following.

An hysterosalpingogram (HSG), an x-ray taken to examine issues within the uterus and fallopian tubes

Blood tests to measure hormone levels related to fertility and reproduction

Ovarian reserve testing, which evaluates the number of viable eggs in your ovarian reserve. These are typically used for women over 35 or those at risk of a low egg count for other reasons.

A semen test is used to diagnose most cases of male infertility. This identifies how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail. In some cases, additional blood tests and/or genital ultrasounds may be used to rule out other health conditions.

Fertility problems do not mean that you won’t be able to have children biologically. There are many treatment options that can help increase your chances of conception. The most effective course of treatment depends on the underlying cause of your or your partner’s fertility issues. These are among the most common fertility treatments.

Forms of assisted reproductive technology (ART) including in vitro fertilization (IVF), a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. In addition to treating female infertility, IVF can also be used when male infertility is a factor.

Intrauterine insemination (IUI), a type of artificial insemination in which sperm that have been washed and concentrated are placed directly into a woman’s uterus during ovulation.

Injectable fertility medications including gonadotropins and oral fertility medications such as Clomid® and Femara® can treat fertility-related hormonal imbalances.

Your doctor may also recommend lifestyle changes or treating a related health condition.

A fertility pharmacy partner you can rely on

Since 2016, Alto has supported more than 50,000 fertility journeys. We understand that fertility treatment is a significant investment — physically, emotionally, and financially — and we see ourselves as a partner in your health.

We offer free, same-day delivery seven days a week and temperature controlled packaging to ensure that your fertility medications always arrive in the right condition. And our fertility-trained pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to offer any support you need.

Reach out any time via phone at 1-800-874-5881, or in-app messaging.

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.

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.

Arteries are a critical part of your circulatory system, transporting blood and oxygen from the heart to the rest of the body. As you age, a variety of substances collectively referred to as plaque — including fats, cholesterol, and calcium — may accumulate in these blood vessels. A condition called atherosclerosis occurs when the buildup of plaque causes the arteries to narrow and obstructs overall blood flow throughout the body. It is a leading factor in the development of coronary artery disease, the most common type of heart disease.

Atherosclerosis, Explained

Many of the key risk factors of atherosclerosis can be managed, and there are effective treatment options that can prevent the condition from worsening. Here’s what to know about causes, symptoms, treatment, and prevention.

Atherosclerosis involves slow, progressive changes to the structure of your blood vessels. These changes typically intensify with age. As plaque accumulates, the walls of your arteries become thicker. This gradually narrows the channel within the artery through which blood flows, reducing the amount of oxygen and other nutrients that the rest of your body receives. In some cases, pieces of plaque can break off into the bloodstream and lead to the development of a blood clot.

There are arteries in nearly every part of the body, and three main types of arteries: elastic arteries, muscular arteries, and arterioles.

Elastic arteries come out of the heart and contain more elastic tissue than other types of arteries. Their flexibility allows them to receive blood at high pressure. Examples include the pulmonary artery and aorta.

Muscular arteries have less elastic tissue and more smooth muscle fiber, which allows them to expand and contract to control the flow of blood. Examples include the coronary and femoral arteries.

Arterioles are smaller vessels that branch out from the arteries and help distribute blood into microscopic capillaries.

Atherosclerosis is not limited to a certain area or type of artery. Plaque may develop in arteries in the heart, brain, pelvis, legs, arms, or kidneys. The type of artery affected in atherosclerosis can impact an individual’s symptoms, along with their risk for related health complications.

Different health conditions may arise depending on where plaque accumulates.

Coronary artery disease occurs when plaque accumulates in the arteries in or leading to the heart.

Angina, a type of chest pain, can also arise from plaque accumulation in the coronary arteries. It results from decreased blood flow to the heart muscle.

Carotid artery disease occurs when plaque accumulates in the neck arteries that deliver oxygen-rich blood to the brain.

Peripheral artery disease (PAD) occurs when plaque accumulates in the arteries in the arms and legs.

Kidney disease occurs when plaque accumulates in the renal arteries, which transport oxygen-rich blood to your kidneys.

In addition to the conditions above, extensive plaque accumulation can lead to other health complications, including heart failure, a heart attack, an abnormal heart rhythm, a stroke, and an aneurysm. Treatment can help slow the progression of atherosclerosis and prevent more serious complications.

Many factors play a role in the development of atherosclerosis, including the following.

Atherosclerosis is among the more common aging-related health issues. Your heart and blood vessels have to work harder as you age. These changes can stiffen the arteries, which makes it easier for plaque to accumulate in them.

Cholesterol is a waxy, fat-like substance that’s produced naturally by the liver and also found in certain foods. It isn’t inherently bad — your body needs a certain amount of cholesterol to produce cell membranes, hormones, and nutrients. However, high levels of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol) can accumulate in the walls of your arteries and turn into plaque, factoring into a person’s risk for heart disease and stroke. (Conversely, a healthy level of high-density lipoprotein (HDL) cholesterol can potentially lower your risk for heart disease.)

Smoking damages your blood vessels and accelerates the buildup of plaque. It is a leading risk factor for peripheral artery disease. 80% of those with PAD are current or former smokers. Smoking is also associated with plaque accumulation in the aorta — the main artery of the body —  and in the coronary arteries.

High blood pressure strains and damages your coronary arteries, causing them to gradually narrow as plaque accumulates.

You may have a greater risk for atherosclerosis if you have diabetes or a family history of atherosclerosis. Physical inactivity and obesity also play a role.

Atherosclerosis symptoms typically do not appear until an artery has become severely narrow or clogged, to the point where blood flow is affected. There often aren’t noticeable symptoms of mild atherosclerosis. Symptoms of moderate to severe cases vary by the affected artery.

Atherosclerosis in coronary arteries: chest pain or pressure

Atherosclerosis in the arteries leading to your brain: sudden numbness or weakness in arms or legs, difficulty speaking, confusion, or drooping facial muscles

Atherosclerosis in the arteries in your arms and legs: pain in your legs while walking or decreased pressure the affected limb

Atherosclerosis in the arteries leading to your kidneys: high blood pressure or weakened kidney function

If you have any concerns about potential symptoms of atherosclerosis, contact your doctor as soon as possible for an evaluation.

Atherosclerosis cannot be reversed, but it is treatable. A heart-healthy lifestyle and medications can help slow the accumulation of plaque and prevent the condition from worsening.

Lifestyle changes such as quitting smoking, planning a heart-healthy diet, and exercising more frequently are often a first step in treating mild atherosclerosis. The American Heart Association suggests aiming for about 150 minutes a week of moderate-intensity aerobic activity. Building these healthy habits early on can also help prevent atherosclerosis from developing to begin with.

Your doctor may also recommend medications to prevent atherosclerosis from progressing further. The following medications are commonly used to treat atherosclerosis.

Statins such as atorvastatin and simvastatin act on the liver to prevent LDL cholesterol from forming and limit the overall amount of cholesterol circulating in your bloodstream.

Fibrates such as fenofibrate and gemfibrozil can raise HDL cholesterol and lower LDL cholesterol.

Niacin is a B vitamin that reduces the liver’s production of blood fats and can lower LDL cholesterol.

For more on cholesterol-lowering medications, read How to Manage High Cholesterol: Diet, Medications, and More.

Beta blockers such as metoprolol and carvedilol cause the heart to beat more slowly and less forcefully, lowering your blood pressure.

Calcium channel blockers such as amlodipine and diltiazem prevent calcium from entering the smooth muscle cells of the heart and blood vessels, which opens up narrowed blood vessels and lowers blood pressure.

ACE inhibitors such as lisinopril and benazepril block production of a hormone called angiotensin II, which causes blood vessels to narrow. This helps constricted blood vessels expand so that more blood can flow through.

Angiotensin II receptor blockers (ARBs) such as losartan and valsartan function similarly to ACE inhibitors and protect blood vessels from angiotensin II.

For more on blood pressure medications, read Common Types of Blood Pressure Medications.

Antiplatelet medications such as aspirin and clopidogrel may be prescribed to reduce your risk of blood clots.

Surgery may be necessary to treat severe cases of atherosclerosis, or if there is risk of serious damage to your muscle or skin tissue.

At Alto, we make it as simple as possible to manage your risk for chronic health conditions and to stay on top of your cholesterol-lowering or blood pressure medications. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

There are more than 25 million individuals in the U.S. living with asthma, including more than 5 million children. While most asthma cases involve the same common symptoms — shortness of breath, chest tightness, and wheezing — day-to-day life with the condition can vary significantly from one person to another. Not only is there a wide spectrum of the severity and frequency of symptoms, but there are also different types of asthma with distinct causes and triggers. (They are not mutually exclusive, so it’s possible to fulfill the diagnostic criteria for more than one type of asthma.) Here’s what to know about the main types of asthma, including important treatment considerations.

Understanding the Different Types of Asthma

Asthma is a chronic respiratory condition in which the airways in your lungs become narrow and inflamed, often leading to difficulty breathing. There are several different types of asthma: allergic asthma, non-allergic asthma, nocturnal asthma, occupational asthma, cough-variant asthma, and a related condition called exercise-induced bronchoconstriction. While there is variation among these asthma types with respect to causes, triggers, and treatment options, there are also some similarities, including the core symptoms of asthma such as coughing, wheezing, chest tightness or pain, and shortness of breath.

Some people with asthma experience intermittent flare-ups while others have symptoms the majority of the time, or persistent asthma. Persistent asthma can be categorized further as mild persistent, moderate persistent, or severe persistent depending on the severity of symptoms.

Allergic asthma is the most common form of asthma, accounting for about 60% of all asthma cases in the U.S. It occurs when an individual’s immune system interprets substances such as household dust mites, pet dander, or pollen as harmful and releases antibodies that ultimately lead to inflammation in the airways. Allergic asthma frequently involves allergy symptoms like nasal congestion, a runny nose, and itching in the eyes, nose, or ears in addition to core asthma symptoms. There is often a genetic component.

Read When to See a Healthcare Specialist for Allergy Treatment

10-33% of all individuals with asthma experience symptoms caused by triggers other than allergies including a history of smoking or exposure to secondhand smoke, respiratory infections, pollution, cold weather, humidity, and exercise. This is referred to as non-allergic asthma. It often develops later in life in comparison to allergic asthma. As part of the diagnosis process, your healthcare provider will rule out allergies as the cause of your asthma symptoms.

60% of all individuals with persistent asthma also experience nocturnal asthma, a type of asthma in which symptoms worsen at night. Those with nocturnal asthma frequently have their sleep interrupted as a result of coughing, wheezing, or chest tightness. There are many factors involved in the development of nocturnal asthma including smoking; dust or other allergens; and other illnesses or health conditions such as the cold, flu, sinusitis, gastroesophageal reflux disease (GERD), and sleep apnea. Your circadian rhythm and nightly fluctuations in the hormones epinephrine and histamine are also believed to play a role.

Since your daytime breathing can’t be used to diagnose nocturnal asthma, your doctor may ask you to test your breathing at home or participate in a sleep study to confirm a diagnosis.

Occupational asthma occurs when you are exposed to chemicals in your work environment that affect your respiratory function and breathing such as paint, cleaning products, mold, fungi, or dust. 11 million individuals in the U.S. are exposed to an occupational asthma-linked substance at their workplace. Workers who may have a higher risk for occupational asthma include bakers, farmers, metal and plastics workers, woodworkers, and those who work in manufacturing.

As many as 90% of individuals with asthma experience respiratory symptoms during physical activity — a subcategory of asthma known as exercise-induced bronchoconstriction (EIB). Exposure to airborne irritants including smoke, pollution, and pollen and/or to cold, dry air may contribute to symptoms.

There is much variation in individual experiences of EIB symptoms. Some individuals begin to have difficulty breathing right when they start exercising while others have more noticeable symptoms shortly after they return to a state of rest. Symptoms quickly disappear in some cases but last up to 24 hours in others.

If you have symptoms of exercise-induced bronchoconstriction, it’s important to stay active. Rather than avoiding exercise to prevent an asthma flare-up, speak with your healthcare provider about your asthma treatment plan and look for forms of exercise with an appropriate level of intensity.

In some cases, a dry cough is a symptom of cough-variant asthma. This type of asthma is more common in children than adults. It can be difficult to diagnose since a dry cough is also linked to other health conditions. If your cough wakes you up at night, worsens in cold, dry weather or after exposure to allergens, or occurs after exercise, you may have cough-variant asthma.

30% of all individuals with cough-variant asthma eventually develop classic symptoms of asthma. The goal of treatment for cough-variant asthma is to prevent the condition from progressing into a more severe form. Inhaled corticosteroids, which reduce inflammation and swelling in the airways, are the frontline treatment for cough-variant asthma.

All types of asthma can be managed with a combination of asthma medications, healthy lifestyle habits, and additional preventive measures to avoid triggers. However, given the spectrum of severity of symptoms — and the variety of asthma triggers — there isn’t a one-size-fits-all approach to treatment. Your doctor will advise you on the most effective treatment plan for your individual needs. 

If you have mild asthma, you may only need quick-relief rescue medications to manage acute symptoms. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) and Levalbuterol (Xopenex HFA®) are common quick-relief asthma medications. They may be taken via inhaler or nebulizer.

If you have moderate to severe asthma, you may need long-term maintenance medication in addition to a rescue medication for flare-ups. There are two main types of long-term asthma control medications:

Inhaled corticosteroids including Flovent® HFA and Qvar Redihaler® 

Combination inhalers that contain both corticosteroids and long-acting beta agonists (LABAs) including fluticasone and salmeterol (Advair Diskus®); budesonide and formoterol (Symbicort®); mometasone and formoterol (Dulera®); and fluticasone and vilanterol (Breo Ellipta®)

If you have allergic asthma, your doctor may also recommend over-the-counter or prescription allergy medications such as oral antihistamines (Claritin®, Allegra®, Zyrtec®), decongestants  (Afrin® and Sudafed®), and corticosteroid and cromolyn nasal sprays. While these medications can help you avoid allergy-induced asthma attacks, they are not a substitute for classic asthma medication. If you have nocturnal asthma, your doctor may recommend adjustments to the timing of your dosages to help you experience a better quality of sleep.

To learn more about asthma medication and management, read A Guide to Common Asthma Medications.

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

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your asthma treatment plan.

Last summer, Moringa Fellows Irma Figueroa and Adrian Mendez joined Alto as the company’s second batch of engineering interns. Here, they share their learnings, accomplishments, and advice for future Alto interns.

Two Engineering Interns Weigh In: What to Expect From Your Alto Internship

The Moringa tree flourishes almost anywhere it’s planted. It’s hardy, fast-growing, and resistant to drought — an apt metaphor for the two interns who joined us from the Moringa Fellowship program last summer.

“Before Alto, I had never actually contributed to a large codebase,” admits Irma Figueroa, an intern on the Supply Chain Team. By the end of their three-month internships, however, Irma and fellow intern Adrian Mendez had shipped impactful features for Alto’s internal pharmacy management system and customer-facing app that are still in production today.

Below, we chat with Irma and Adrian to learn what it was like interning at Alto, which projects they worked on, and what advice they’d give to future interns. 

Adrian, who interned on the Patients Team before returning to join as a full-time software engineer last fall, was surprised by the freedom he had to choose what he worked on during his internship: “Early on, my manager gave me a rundown of the projects the team was juggling and the option to choose which one interested me the most,” he says. “I was able to decide the kind of experience I was going to have.” 

Adrian adds that meetings with his mentor evolved over the course of his internship, as he became more familiar with the codebase: “From the start, we had weekly meetings to talk about whatever was on my mind. Those meetings started off as general advice and questions and turned into more time to pair or run things by each other.”

Because both Adrian and his mentor were working on the same, long-term project, some of those meetings were also dedicated to project work. This included “sitting with [my mentor] while creating the project outline, pairing on larger tasks, and syncing up on progress.” 

Which projects did you work on during your internship? 

On the Supply Chain Team, Irma was tasked with a unique inventory challenge: Technicians at our production pharmacy locations use handheld scanners to scan the barcodes on newly-received inventory. Our technicians often need to scan hundreds of inventory items at a time — making it all too easy to lose track of which items have been successfully scanned onto which shelves. 

“I created a reusable counter component, displayed in the header of the scanner app, that would represent the number of items scanned into a shelf.” Irma says. The best part? Getting to test the handheld scanner herself. “I really enjoyed using the scanner for testing purposes. It was rewarding to see my code in action and definitely super fun!” 

On the Patients Team, Adrian worked on a project to add a homescreen to the customer-facing native app. Previously, the app dropped users into a list of all their active medications, which made it difficult to know where to look or what to do next. The new homescreen allows users to schedule the prescriptions most relevant to them and to view or edit any upcoming deliveries. 

“The first step was to create new additions to the design system — essentially taking the designs and extracting system-wide components. After that, the fun part was taking all those components and putting them together like building blocks!” Adrian says.

It was especially rewarding, he adds, to have been part of the project from start to finish. “I joined right as the design phase started, and I was there mostly every step of the way. For how short my time here was, having helped create this landmark project is really cool to think about.” 

What advice would you give to future Alto interns?

Irma and Adrian agree: Don’t be afraid to ask for help. “You'll often feel challenged and possibly intimidated, but be patient with yourself and remember you have an entire team of experienced engineers ready to help,” Irma says. 

“Everyone at Alto is more than willing to help you out, so don't be afraid to ask questions! You're on the same ship as everyone else, so your success equals everyone’s success,” Adrian adds. “Just remember that your work got you here, and they wouldn't have invited you if they thought you couldn't handle it. They made an investment in your ability to grow, so stay curious.” 

Interested in interning at Alto? Check out our careers page here.

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise.

Managing the Costs of Insulin

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise. Take a look at these recent statistics:

The cost of insulin increased by an average of 14% every year from 2012 to 2018.

In 2017, insulin accounted for 20% of all diabetes-related healthcare spending before rebates and discounts and 6.3% after rebates and discounts.

In a 2018 survey on insulin affordability conducted by the American Diabetes Association, 39% of the respondents reported an increase in their insulin costs between 2017 and 2018.

Rising insulin costs can significantly impact an individual’s ability to manage their health. 27% of those surveyed by the ADA said that insulin prices affected how much of the medication they could buy or use. Missed insulin doses can lead to serious health complications including diabetic ketoacidosis.

While insulin access remains a critical issue for many Americans with diabetes, lawmakers have recognized the urgency of lowering insulin costs. In November 2021, the U.S. House of Representatives passed the Build Back Better Act, which caps out-of-pocket copays for insulin at $35 per month. The legislation has yet to pass in the U.S. Senate, but President Joe Biden recently reaffirmed his commitment to lowering insulin costs — and prescription medication costs more broadly — as part of his domestic agenda.

In the meantime, there are a variety of resources to help you manage the costs of insulin, including patient assistance programs and copay savings cards from insulin manufacturers. Here’s more on eligibility for these programs.

The Lilly Cares® Foundation Patient Assistance Program

The Lilly Cares Foundation Patient Assistance Program provides free insulin and glucagon products for individuals who have Medicare Part D or no health insurance coverage and meet certain income requirements.

Learn more about program terms and conditions and the application process.

The Novo Nordisk® Patient Assistance Program

The Novo Nordisk Patient Assistance Program provides insulin and other diabetes medications at no cost to individuals who have Medicare or no health insurance coverage and whose total household income is at or below 400% of the federal poverty level.

Sanofi Patient Connection provides Sanofi medications including insulin at no cost to individuals whose total household income is at or below 400% of the federal poverty level.

The Lilly Insulin Value Program offers all Lilly insulins at $35 per month to individuals with commercial health insurance or no health insurance coverage. Download the copay card here.

Sanofi offers a copay savings card for those with insurance as well as the Valyou Savings Program for those without insurance, which offers Sanofi insulin at $99 per month. Learn more about Sanofi savings opportunities.

Novo Nordisk offers savings cards that reduce copays for a variety of insulin products. Get more details here.

Your financial well-being is our priority

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your insulin and other medications as affordable as possible. In addition to automatically applying any coupon savings, we’ll connect you with any outside programs that require you to apply directly.

We also offer free, same-day delivery to simplify your diabetes management, and our dedicated diabetes support team is here to answer any questions you may have. Get started or learn more about Alto, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart.

What to Know About Heart Failure

Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart. While heart failure is a progressive condition with the potential for serious health complications, it can be managed through lifestyle changes and medication. Read on to learn about heart failure symptoms, causes, and treatment options.

In all cases of heart failure, the heart cannot deliver enough blood and oxygen to the rest of your body. Sometimes this is because weakened heart muscle leaves the heart’s main pumping chambers — the ventricles — unable to carry out their pumping function. This type of heart failure is called heart failure with reduced left ventricular function (HF-rEF). In other cases, the ventricles are too stiff to fill with enough blood between beats. This type of heart failure is called heart failure with preserved left ventricular function (HF-pEF).

Ejection fraction (EF) is an important measurement of heart function for those who have heart failure with reduced left ventricular function. Expressed as a percentage, EF measures the amount of blood pumped from the left ventricle when it contracts. An EF of 55 to 70% is considered a healthy range.

Since heart failure is a progressive condition, your EF gives your doctor insight into any changes in your heart function. An echocardiogram is the most common way to measure your EF, but a magnetic resonance imaging (MRI) scan or nuclear stress test may also be used.

Despite the importance of EF, it is not the sole determinant of heart function. Those who have heart failure with preserved left ventricular function may have a normal EF. These cases of heart failure are often caused by high blood pressure, which gradually thickens the ventricles. Stiff ventricles cannot relax enough to fill to their full capacity, which is why they do not pump out enough blood.

Heart failure can affect many other organs, including the lungs, liver, and kidneys. The potential for additional health complications increases as heart disease progresses, which is why it’s important to stay proactive about your health and follow your doctor’s recommendations for treatment.

Heart failure primarily occurs as the result of other health conditions that weaken or stiffen the heart. Coronary artery disease, the most common type of heart disease, is the leading cause of heart failure. The condition gradually narrows and thickens the arteries that supply your heart with blood and oxygen. Severe blockages in the arteries can prevent the heart from pumping enough blood, leading to the development of heart failure.

High blood pressure is another common cause of heart failure, particularly cases of heart failure with preserved left ventricular function (HF-pEF). If you have high blood pressure, your heart has to work harder to deliver blood to the rest of your body. Over time, this can make your left ventricle too stiff to properly pump out blood.

Both type 1 and type 2 diabetes are linked to heart failure, as high blood sugar can affect your blood vessels and cardiac nerves. Heart failure may also be caused by a variety of heart health conditions including cardiomyopathy, congenital heart disease, heart valve disease, and arrhythmias.

Lifestyle factors such as smoking, eating a high-cholesterol or high-sodium diet, heavy alcohol consumption, and a lack of physical activity may increase your risk for heart failure, especially if you have one of the conditions above.

These are some of the most common symptoms of heart failure:

Shortness of breath when exercising or lying down

Fatigue and a feeling of weakness in your legs

Swelling in your ankles, legs, and abdomen

A persistent dry, hacking cough or wheezing

There is a spectrum of severity of heart failure cases, and treatment varies by individual depending upon symptoms and heart function, as well as the underlying cause. If you have early-stage heart failure, your doctor may recommend lifestyle changes and prescribe medications that can alleviate symptoms and prevent the condition from progressing.

The following medication classes, many of which lower blood pressure, are commonly used to treat early stages of heart failure.

Angiotensin converting enzyme (ACE) inhibitors

Often used to treat high blood pressure, ACE inhibitors block production of a hormone that causes blood vessels to narrow, helping constricted blood vessels expand so that more blood can flow through.

Like ACE inhibitors, ARBs protect blood vessels from a hormone that causes them to narrow, lowering blood pressure.

Another medication class commonly used in the treatment of high blood pressure, beta blockers cause the heart to beat more slowly, which lowers your blood pressure and opens up your veins and arteries.

Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels so that the heart can beat with less force. This opens up narrowed blood vessels and lowers blood pressure.

If you have atrial fibrillation — an irregular heart rate condition — or another heart health condition, your treatment plan for heart failure may include anticoagulants, medications that reduce the blood’s ability to form new clots and prevent existing clots from growing.

Cholesterol-lowering medications such as statins may be used to treat those who have early-stage heart failure and high cholesterol.

Many people with heart disease retain fluid. Diuretics, also referred to as water pills, can help eliminate excess water and sodium, which reduces the heart’s workload.

Small lifestyle changes are an important part of managing mild to moderate cases of heart failure. They can help alleviate symptoms and slow the progression of the condition. Here are some of the lifestyle changes your doctor may recommend.

Avoiding or limiting your caffeine intake

Anyone can benefit from these lifestyle changes, even those who do not have heart failure. Heart-healthy living is a lifelong practice, and the best way to prevent health issues like heart failure in the future is to prioritize your heart health today.

Some individuals with more advanced heart failure may need a procedure such as coronary bypass surgery or an angioplasty, both of which target a blocked coronary artery. Pacemakers may also be used to help control the rhythm of their heart, often in tandem with a bypass surgery and medications. 

Protect your heart with support from Alto

At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

With more engineers contributing to Alto’s codebase than ever before, we needed to establish better boundaries: which team owns what? Here’s how we developed a tagging-based solution to code ownership and drove and measured adoption.

How We Established Better Boundaries and Clearer Code Ownership at Alto

Some problems are nice to have. Over the course of 2020 the engineering team at Alto saw explosive growth, expanding from about fifteen to more than seventy individual contributors. Growth at this pace required us to rethink our team structures and priorities more than once. This growth felt amazing: the new capacity enabled us to make progress on our backlogs like never before.

But still, there were challenges. We saw a steady rise in merge conflicts as more people contributed to the same code base. Build times increased as more and more code was contributed. A big influx of new perspectives and talent also meant new gaps in historical context and responsibility. New teams took big bites out of their new priorities — great! But what about the old ones? Who was going to fix that bug? Who needs to review this PR? Who is accountable for this performance problem?

Who, in short, owned what? By the end of 2020, it was clear to us that a good, practical, working answer to this question would be the critical first step to continuing smooth, rapid, distributed iteration on our product.

Up to this point, the large majority of product development at Alto had happened in the context of a Ruby on Rails monolith, which — over a half decade of intense development — had grown pretty large. We’d stuck more or less to the default Rails convention of organizing code by function rather than feature, which meant that our code was distributed across a few mostly flat and very broad subdirectories such as '/models' and '/controllers', making it difficult to learn much about the structure and ownership of our business domains by merely looking at how the code was laid out. We knew that this was not going to work for us over the long term.

Our long term vision started to coalesce around a notion of “better boundaries.” First, we would modularize the monolith along the lines suggested by Shopify’s packwerk utility. Then, we would carve some of those modules out into separate engines that could be built and tested separately. Finally, we’d deploy and operate some of those engines independently as their own services. Clear ownership was fundamental to this plan: on either side of an effective boundary, you need to know not just what it is but also who owns it. We lacked that clarity.

The RFC (Request for Comments) we ultimately adopted opened with four questions:

How might we produce a domain model and do something useful at the same time?

How will we avoid imposing (the wrong) prescriptive model from the top down?

How will we keep it up to date and accurate?

We considered jumping straight into moving files around into a more modular structure. Ultimately we decided against this approach as a first step for a number of reasons. The benefit of moving files around is mostly abstract — it’s not immediately clear what to do with a better module structure. It’s relatively expensive to move files around in a Rails app — doing so typically requires you to rename the contents (and update all its callers), which amounts to a lot of busy work, and it’s extra expensive to be wrong. And the in-between state is rough: which example should I follow in deciding where to put my new file? First you are obligated to create a map of the future state, and then to keep that map in sync with reality as you go.

Instead, we opted for a lightweight solution that would allow us to map our domains and their owners in the code itself — helping to ensure it’s up to date and accurate — without having to restructure it at the same time. We’d do this by tagging code in code comments, and then building tools to leverage these tags in various ways to increase visibility and enforce ownership. This has the nice effect of producing a new domain map incrementally from the bottom up, rather than prescriptively from the top down.

Blog

Infertility, Explained

Atherosclerosis, Explained

Understanding the Different Types of Asthma

Two Engineering Interns Weigh In: What to Expect From Your Alto Internship

Managing the Costs of Insulin

What to Know About Heart Failure

How We Established Better Boundaries and Clearer Code Ownership at Alto

Protect Your Eyes From Screen Fatigue

What to Know About Metformin

How We Used Kafka to Build an Event-Driven Automation Pipeline and Scale Our Pharmacy

Developing Robust Authentication Using Rails, Omniauth, and Okta

Fertility Preservation Options After a Cancer Diagnosis

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