Since 2016, Alto has supported over 20,000 patients through their fertility journey. In this post we'll provide guidance on how to select the right fertility pharmacy. In addition, we'll share the benefits of selecting Alto as your fertility pharmacy. 

What to Consider When Selecting a Fertility Pharmacy

Your Choice of Fertility Pharmacy Matters

Chances are if you’re reading this you’ve made a decision to undergo fertility treatment or know someone who might be soon. To begin with, know that you are not alone. Approximately 1 in 8 women in the US are affected by infertility, and more than 20,000 women have now decided to have their eggs frozen. 

Since 2016, Alto has supported over 20,000 patients through their fertility journey, and several team members have gone through the journey themselves. We know this can be an emotionally, financially, and physically challenging experience. That’s why we believe choosing the right pharmacy can help you avoid additional stress caused by waiting for hours on hold, tracking down your medication delivery, and navigating insurance benefits.

Think of your pharmacy as an extension of the care you receive from your physician. You wouldn’t choose just any fertility clinic, right? The same goes for where you choose to receive your fertility medications. Fertility treatment is stressful enough. Your pharmacy partner should provide the reassurance and reliability you deserve.  

In this post we'll share guidance on how to select the right fertility pharmacy. First, we’ll explain why it's important to use a pharmacy with a strong fertility focus (versus any neighborhood or mail-order pharmacy). And since not all fertility pharmacies are the same, we’ll also offer five considerations to make sure you have the smoothest experience possible. Finally, we’ll share the benefits of selecting Alto as your fertility pharmacy. 

At a minimum, credible and experienced fertility pharmacies will employ:

An expert clinical team: This includes pharmacists who are knowledgeable on and experienced with the medications and dosing unique to fertility treatments.

Temperature controlled packaging: Medications can go bad if they are not shipped or stored at the proper temperature. Fertility pharmacies will provide the appropriate packaging to ensure your medications arrive in good condition. This is especially important in warm climates. 

Proper supplies: Fertility pharmacies will be familiar with the variety of needles/syringes that you may need for your injection. This is crucial because it can be stressful if incorrect supplies are included which may lead to a missed dose. In addition, supplies such as alcohol swabs and disposal containers should always be included.

Learn more: [The View From Both Sides of the Fertility Pharmacy Experience]

Here are five additional things you should consider when selecting a pharmacy partner: 

1) Easy, proactive communication - After your clinic sends your prescription to the pharmacy you’ll likely have questions related to insurance, what to expect when receiving your medications, and most importantly, when they will be ready. For that reason it’s important to take into account what types of communication are offered - phone, text, email, mobile app - and typical response times and operating hours. Pharmacies with weekend/evening support hours are most beneficial in ensuring you’ll get live support when you actually need help.

2) Affordability assistance - Fertility benefits are confusing and it can be hard to understand just how much you’ll need to spend on medications. Most fertility pharmacies will work with leading financing and loan providers and can administer manufacturer discount programs if asked. A great fertility pharmacy will go above and beyond to connect you with financial assistance programs for qualifying prescriptions.

3) Local, timely delivery - Your medication protocol can change even after you start your injections - perhaps your physician wants to add a different trigger shot to prevent over-stimulation or decides to add days to your schedule because of the rate at which your follicles are growing. You can avoid these stressful situations if you select a pharmacy that is local and can promise fast same-day delivery. The last thing you need to worry about is mail-order delays or waiting in line at a pharmacy for hours. 

4) Pharmacist support - You’ll most likely have questions about your fertility medications (i.e. How do I know I’m injecting correctly? My clinic just changed my medications, what do I do?) so think of your fertility pharmacist like an extension of your #TTC community in that they should be an advocate on your side. Make sure the pharmacy you choose offers support and expert resources like guidance on injections, tools for managing your protocol and help understanding medication options - including late at night and on the weekends!

5) Community reviews - Just like you researched clinic and physician reviews, you should do the same with your pharmacy choice. Head to Yelp, Facebook, and any other feedback platform that showcases patient testimonials. Pharmacy experience matters but so does the experience of others. See if any reviews or blogs exist that mention specific fertility pharmacies. You’ll thank yourself (and those before you) for taking the time to do your due diligence. 

The fertility team at Alto will reach out as soon as we get your prescription so you don’t have to worry about waiting on hold or standing in line at a pharmacy. We’ll proactively investigate your insurance coverage, provide options to maximize your benefits and offer qualifying rebate programs. 

And because we know you’re busy with life, we offer a mobile app that allows you to securely schedule your delivery or message a pharmacist if you aren’t able to call us. You can take care of your pharmacy needs wherever you are and on your schedule. Alto pharmacists are always available until 9 pm each night (including weekends) to answer questions. 

When it comes to the time sensitive nature of your treatment, being locally-based makes a critical difference. Medications may be increased, decreased, or stopped altogether. At Alto, patients always receive free, same-day delivery by our own Alto courier team, even on weekends. 

We also offer the ability to select the 2 to 3-hour delivery window that works best for you either at home or work. Once your delivery is scheduled you’ll receive text updates along the way so you know exactly when your courier will arrive.

Your medications are packaged to give you the necessary information to avoid common mistakes (e.g.which meds go into the fridge). And Alto’s dedicated fertility pharmacists are always just a phone call or text away to answer your questions about injections, supplies, and more. So if you're about to inject and suddenly forget something, you don't need to wake up your physician - you can give us a call.

We’ll also follow up with you to remind you about qualifying rebates and provide instructions on how to apply. Our patients find this especially helpful given they have enough to remember. 

Sam shares why serving fertility patients is so rewarding

The team at Alto is ready to be your partner through it all, from your first cycle to your last. Questions about using Alto? Visit alto.com/fertility or give us a call at 1-800-874-5881. Our team is available 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends. 

What to Consider When Selecting a Fertility Pharmacy 

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

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 via phone, text or the app. 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.

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 or reach out via phone, text, or the app to learn more. 

Reverend Stacey, who is also the Executive Minister at Trinity United Church of Christ in Chicago, sat down with us to share more about the challenges of fertility in the Black community, what fertility care providers can do to create more inclusive experiences, and some of her favorite memories in the history of FFCG. 

Rev. Dr. Stacey L. Edwards-Dunn on Her Mission To Improve Black Fertility Care

When it comes to fertility, there is a lot to navigate—from deciding which treatment option is right for you to figuring out how to afford the costs. In the U.S., about 11% of women experience infertility, and studies suggest that Black women are twice as likely to face infertility as white women. 

Rev. Dr. Stacey L. Edwards-Dunn is trying to change this. After working as a health educator in Chicago and an education director at Planned Parenthood, she founded Fertility for Colored Girls (FFCG) in 2013. As a 501c3, FFCG’s mission is to provide education, awareness, and support to Black women/couples and other women of color who struggle with infertility—something Stacey wished she’d had when she was on her own infertility journey. 

With 14 chapters across the country spanning urban and suburban communities, and with more opening each year, FFCG provides services including educational programs, grant opportunities, counseling, and monthly support groups where women can share their experiences and receive support.

What are the reasons Black women are almost twice as likely to experience infertility as white women?

There are a few factors behind this. The first is that in the Black community, infertility is a taboo topic. And it’s not something we expect to experience. In our communities, we have believed the hype that Black women are hyper-fertile. Much of this comes from breeding myths during slavery around our ability to be able to give birth. But the reality is, these myths are incorrect. So it begins with how we have been socialized and educated around our own reproductive health and our Black bodies. 

A second reason is that there are many Black women and couples who don’t trust the medical system. And because of this distrust, we’re not accessing health care. We think doctors don’t take us seriously and impose their biases on us. And even today, we still hear stories of Black women and couples having surgeries done on them and being sterilized without permission.

A third reason has to do with research. Most of the research around reproductive health and treatment has primarily been done on white women. So when research shows that in vitro fertilization (IVF) is not as successful with Black women, it’s because the trials haven’t included Black women. Once we start seeing more research done that includes black and brown women and other ethnicities then we’ll be able to tailor treatments better. 

A final reason has to do with marketing. We still have a number of fertility clinics that aren’t including women and babies of color and other ethnicities in their marketing. So Black women and couples don’t see themselves in the marketing and if you can’t see yourself, it makes it harder to feel welcome and to trust that you’ll get quality care. 

In addition to marketing and staffing, what other recommendations do you have for clinicians and fertility care providers to create a more accessible and equitable experience? 

I would say education. The staff working with women of color need to be educated. They need to be equipped with tools on how to be culturally sensitive to the Black women and couples that are coming into their spaces. Something I hear from Black women and couples is they want the doctor and team to partner up with them in their treatment—not to look down on them or talk at them. They want someone to walk with them on their journeys. 

Education can also help staff understand their own biases which, a lot of the time, they’re unaware of. It’s important they know what to say and what not to say to make sure they aren’t deterring Black couples. In addition, Black and other ethnicities need to be represented in executive roles and throughout the organization —from doctors to nurses to lab technicians. Making sure staff is inclusive, diverse, and culturally-educated.

Finally, they need to work with organizations like FFCG, who have their pulse on the community and can help them create relationships with the Black community. And they should be open to having these conversations not just during Black History Month, but all the time.

For the communities you work with and those who might not understand their family building options and the resources available to them, what do you want them to know? 

I want them to know there are multiple paths to parenthood. And though they are all different, they are not deficient. When I educate the women and couples I coach and that come to me, I help them focus on the goal, which is to be parents and to build a family. When you know the goal, then you can understand that you have other natural options, like IVF, intrauterine insemination, donor eggs or donor sperm, domestic adoption, et cetera. 

There is an option and a path that has been designed for everyone and I help them see that. Because when you have options, there are possibilities. I am very intentional about helping to open up the minds of the women and couples that I work with to help them see the goal. Because when you reach the goal of becoming a parent to a child, the reality is that you’re not going to love them any less because it is the child that God has sent you.

Is there a particular memory or moment that stands out for you since you founded Fertility for Colored Girls?

A powerful moment for me was when we gave away our first free IVF [cycle] to a couple. After experiencing a few unsuccessful IVF [rounds], they didn't have any money left and their state of Mississippi doesn’t have insurance toward infertility treatments. So they put their name into our raffle and won. They took the Megabus from Mississippi up to Chicago, Illinois to meet everybody that they had been talking to on the phone during prayer time. 

At this time, I was also one month away from giving birth to my daughter after seven in vitro cycles, so I really felt for them. Now they have five-year-old twins. This was significant because it was the first time we were able to provide physical resources to a couple in need. 

In addition to this, I am always so honored when women and couples call me and tell me they got a positive pregnancy test after IVF, or that their surrogate is pregnant, or their adoption just got approved. Often, I end up finding out before anyone else in their family does. I’m so honored that these women and couples trust me to share their journeys and their hearts. And most of them have never met me in person, they’ve just talked to me on the phone. 

These are women who have cried so many tears in silence and lived so long in shame, and they’ve found a successful path to starting a family. That is what gives me joy and fuels me to keep doing the FFCG work. It reminds me there’s still hope and the work that we are doing is not in vain. 

Is there anything else you’d like to highlight about your work with FFCG and your mission?

I will add that I think you are able to have peace on your [infertility] journey when the mind, body and spirit are aligned. Because if any of those aspects are not aligned everything can really fall apart. Therefore, my approach, and the mission of FFCG, is to minister to each aspect of a person’s life as they are all equally important. 

In addition, it’s important for people to know the resources that are available to them through FFCG—from grants they can apply for to education to support in our prayer circles. Many Black women and couples struggle with having the resources and support to move forward, so I want to make sure they know this.

To support or donate to Fertility for Colored Girls visit the FFCG site. You can also learn more about the Black Reproductive Endocrinologist and Infertility Specialists making history and bringing hope to their families on 2/25 at 6 pm CT. Register here.

At Alto, we know fertility treatment can be an emotionally, financially, and physically challenging experience. That’s why we believe choosing the right pharmacy can help you avoid additional stress caused by waiting for hours on hold, tracking down your medication delivery, and navigating insurance benefits.

It’s normal to feel overwhelmed with egg freezing, but thankfully there are individuals on the other side of it who are willing to share their experience. Read on to hear what egg freezing was like for two members of our team.

Two Women Share Their Egg Freezing Journeys

It would be a serious understatement to say that we are living in uncertain times. For those interested in parenthood, the unpredictability of COVID has, in some cases, delayed starting a family. It’s no surprise, then, that more and more people are now considering egg freezing, a process that allows you to freeze unfertilized eggs, store for future (or later) use, and leave open the possibility of starting a family in the future. 

And with ample room for reflection and planning, not to mention work-from-home arrangements conducive to frequent doctor’s appointments, the pandemic has proven to be a convenient time to start the process. Clinics across the country saw a significant uptick in egg freezing during 2020. 

While egg freezing can be an empowering process that provides otherwise hard-to-find control over your future, it’s also a significant emotional and financial investment, with an intensive medication schedule, too. It’s normal to feel overwhelmed or unsure of what to expect, but thankfully there’s lots of individuals on the other side of it who are willing to share their experience. Read on to hear what egg freezing was like for two members of our team, and view our previous post on egg freezing and IVF for an overview of the process.

“It was always in the back of my head, and now I have the relief of knowing I’m preserving multiple options for the future.”

Grace, 27, a provider success specialist on Alto’s fertility team, knows firsthand how convenient it is to work from home while going through the process of freezing your eggs. “The pandemic was actually a great time to do it,” she says. “It was a lot more manageable to do the injections at home and be uncomfortable and bloated in my own space rather than at the office.”

Grace’s professional background in fertility motivated her to reflect on her own reproductive goals. She knew she always wanted kids, but since she didn’t see herself starting a family in the near future, egg freezing felt like an appropriate next step in her journey. 

Grace first started the process at 24, taking an AMH blood test to learn more about her egg count. She had fewer eggs in her ovarian reserve than the average for her age. After completing two egg freezing cycles in January and April of this year, she did not retrieve the minimum number of eggs she was aiming for and thus plans to do a third cycle to reach her goal of at least ten frozen eggs.

While the outcome isn’t what she had hoped for, she’s grateful that the test helped manage expectations, and to have learned earlier rather than later that her fertility journey will involve multiple rounds of egg freezing.

“After the AMH, I wasn’t sure if this would even work for me,” she says. “The results from the retrievals are better than nothing, and I’m really grateful I found out at age 26 and not at 30.”

Here’s more about Grace’s egg freezing journey, in her own words.

What was your experience of the egg retrieval like?

Grace: In my experience, the retrieval itself was actually the least intimidating part. By that point, your body has already done everything it needs to do. All that’s left is showing up for the quick procedure, which takes twenty to thirty minutes. It was all out of my hands so I tried my best to just relax. Because of COVID, no one else could come with me, which isn’t usually the case. Fortunately I had the added comfort of working with doctors I already knew since I completed the process at the clinic where I was working at the time.

What was the hardest part of the process?

Grace: For me, it was getting the numbers back after the first retrieval and learning that there weren’t as many eggs as everyone expected for my age — I got a total of nine eggs from my first two rounds combined and the typical range for a woman my age is fifteen or more. I’ll have to go through the process again if I want to reach a goal of a certain number of eggs for the future; generally the target is at least ten frozen eggs. 

It can feel isolating to have a low egg count if you know other people who went through the process and had a different outcome, like I did, which can feel as if your body isn’t working the way it’s supposed to. As disappointing as it is, at least I have this information early so I’m able to plan for other options.

What do you wish others knew about egg freezing?

Grace: I wish more women knew about the AMH test — which tells you the number of remaining eggs in your ovaries — and the importance of getting tested as early as possible. Knowledge is power. No one expects to have low numbers. From both my own journey and my work with lots of patients over the years, I’ve seen firsthand how devastating it can be to get this information when you're ready to start a family, at which point it may or may not be too late. 

The earlier you know your fertility status, the better. That way you can make an informed decision and plan ahead.

Grace: Candles and music got me into a calm headspace before the injections, when my anxiety would spike. Also, honoring what my body was telling me, taking naps when needed, and talking to coworkers who had gone through the process.

Why did you choose Alto for your fertility pharmacy?

Grace: Egg freezing medications can change on the day of a doctor’s appointment depending on ultrasound results, so being able to schedule same-day delivery, even on weekends, without paying extra was really important. It gave me greater peace of mind during what can be a stressful process.

And even though I worked in the field and was familiar with the process, Alto’s injection videos were so helpful, and the reassurance of knowing I could reach out to a pharmacist for support at any time made the whole experience more manageable.

“I wanted a safety net, and this was one thing I did have control over. It was a decision that was only mine to make.”

For Jess, 36, another member of our fertility team, turning 35 was the final push to move forward with egg freezing. “It was always in the back of my mind, but then other life events kept taking precedence and before I knew it, time was running out to make it worth the investment,” she says.

Since the idea of starting a family soon was unpredictable, she decided it was the right time to start the egg freezing process. It didn’t hurt that the experience would double as some user research, as she explains, “I was familiar with the pharmacy aspect of egg freezing through my work, but I wanted to understand the personal experience of actually going through the process.”

Although she completed her egg freezing cycle before the pandemic, she understands how empowering it is to be able to take your future into your own hands, something that’s taken on new importance over the past year. “I realized I couldn’t rely on a partner to be the person I’d start a family with,” she says. “This felt like the one thing I did have some control over.”

The retrieval went smoothly, yielding more eggs than expected, but Jess, who has also considered adoption, is still keeping her options open. For her, that’s one of the biggest benefits of egg freezing: not having to make any immediate decisions about parenthood, but knowing that there’s multiple possibilities still on the table. Below, Jess shares more about her experience with the process.

Jess: There were some delays and the retrieval date got pushed back a few times. I went in on the weekend, and it wasn’t my regular doctor, but I felt confident in my clinical team based on past conversations. I had some complications with blood pressure, but in general the process went well. I ended up with more eggs than expected.

I remember feeling alone afterwards and wanting to sleep all day, but I ended up meeting a friend at the beach, which lifted my spirits. Egg freezing is such an interesting experience because it’s super emotional for two weeks leading up to the retrieval and then it’s just done.

Jess: It’s a really emotionally intense process to navigate on your own. I was thankful to have coworkers who’d been through it to talk to. The delays were hard, too. There was one day when I had to get my blood drawn and it just wasn’t happening even after five tries. By the end, it felt like waiting itself had become such a big part of the process.

Jess: With egg freezing, medication can be complicated. The specific dosages can change based on hormone levels, which are measured through bloodwork and ultrasounds. It’s not uncommon for your doctor to change a prescription the day of an appointment, so if you get all the prescriptions filled ahead of time, there’s a chance some of the medications may not be used. If you use a pharmacy that manages your deliveries as you confirm you need the medications and offers same-day delivery, like at Alto, you can save a lot of money and avoid wasting the medication.

Also, definitely do some research on finding a pharmacy that will help you navigate insurance benefits and potential medication cost savings options.

Jess: I tried not to put my life on hold during the process and stayed active with camping and hiking. As long as I had my medication, I was comfortable. I also got a puppy just before starting the process, which was a big benefit and distraction.

Jess: I wanted to experience firsthand our fertility service, and it was also really important to have a reliable pharmacy partner that made it possible to avoid wasting medication. My clinic had been working with Alto for years, and it was comforting to know that they were in lockstep with each other. Being able to track deliveries in the app was also really reassuring. I didn’t have to worry about where my medication was when it was in transit.

Choose a pharmacy partner with flexibility for your egg freezing journey

Having a reliable but flexible fertility pharmacy partner is especially important during egg freezing, which can involve last-minute changes with medication. Alto offers free, same-day delivery and expert guidance on fertility medication. Our dedicated fertility specialists are also here to guide you through your first injections and work with your doctor to ensure your egg freezing treatment plan is followed correctly.

Visit us at alto.com/fertility or reach out via phone, text, or the app to learn more.

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.

Managing your fertility medications can be stressful but learning more about their purposes and side effects can help with peace of mind. Let’s take a closer look at the main types of fertility medications.

Fertility Medications 101

There are many paths to parenthood. For some, the journey includes fertility treatments like egg freezing or in vitro fertilization (IVF), which help millions of individuals preserve their fertility options or conceive. And while these procedures can help you start the family you’ve always dreamt of, the process can sometimes feel like an overload of information and new things to learn.

Fertility medications are often one of the more overwhelming parts of the journey as they are prescribed on a tightly-timed schedule with specific doses based on hormone levels. Your doctor may decide to change your prescriptions throughout the process based on ultrasounds and bloodwork.

Managing your medications, which are often taken as nightly injections, can be stressful and may take some getting used to. However, learning more about the purposes and side effects of your fertility medications can help with peace of mind. Let’s take a closer look at the main types of fertility medications used for egg freezing and IVF.

The main goal of egg freezing is to retrieve as many mature eggs as possible from your ovaries: the more eggs you have, the higher your chances are of fertilizing one or more eggs and becoming pregnant as a result of IVF. This process involves ovary stimulation to induce follicle growth and egg production.

Stimulation medications used in egg freezing contain three important hormones that cause the ovaries to mature and release eggs: follicle stimulation hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG). Your doctor may prescribe some of the following commonly used stimulation medications:

These oral medications are mainly used during ovulation induction (OI) or intrauterine insemination (IUI) treatments to induce the ovary to produce and release eggs. Both Clomid and Letrozole work by reducing estrogen levels, which then signals the body to generate more FSH.  

Created in a lab, these medications are biosimilar to natural hormones and mimic FSH in your body. They are taken at the beginning of an egg freezing or IVF cycle to help your body produce many follicles, which are fluid-filled sacs in your ovaries that potentially contain an egg.

This medication contains LH and FSH. Like Gonal-f or Follistim, it is introduced early on in an egg freezing or IVF cycle to stimulate follicle production.

Novarel/Pregnyl are both a urinary extracted form of hCG (compared to Ovidrel which is a recombinant, or created in the lab). These hCG medications stimulate the body’s natural LH surge, inducing the final maturation of your eggs and triggering ovulation within 36 hours. They are usually the last injection of your IVF treatment.

This medication also contains hCG but in a recombinant, or lab-made, form. Similar to Novarel/Pregnyl, it is used to promote the eggs' final growth spurt and trigger ovulation.

If you have a decreased ovarian reserve, or if your body doesn’t respond well to the stimulation medications listed above, your doctor may also prescribe omnitrope, a growth hormone whose main purpose is to improve the quality of your eggs. 

Stimulation medications are usually taken as nightly injections. If you have questions about how to self-administer, Alto’s pharmacists are available to walk you through the process via in-app messaging or over the phone. You can also view our step-by-step guides on fertility injections.

When taking stimulation medications, you may experience some of the following known side effects:

Soreness, redness, or mild bruising at the site of injection

Consult with your doctor or pharmacist if you have any concerns about your side effects.

Once eggs are released from the ovaries — known as ovulation — they cannot be retrieved by your doctor and used for the fertilization process, so ovulation suppression medications are critical to completing an IVF cycle. If your fertility journey involves an egg donor or gestational carrier, this type of medication may also be used to coordinate cycles.

These fertility medications work against a hormone called GnRH — which helps produce the ovary-stimulating hormones LH and FSH — to help prevent premature ovulation. Some of the common side effects are abdominal discomfort, headaches, and soreness at the site of injection.

This fertility medication stimulates an initial surge in LH and FSH but ultimately causes the body to stop production of these hormones during a process called downregulation. Common side effects include hot flashes, headaches, mood swings, and vaginal dryness.

Once ovulation suppression medications are added to the schedule on top of the stimulators, some people develop ovarian hyperstimulation syndrome (OSH). In this condition, overproduction of follicles causes extreme swelling or pain in the ovaries. Your doctor may recommend taking medication to help control symptoms or canceling treatment until a future cycle.

In IVF, after your doctor has completed the egg retrieval, the eggs are fertilized and then transferred to your uterus through a quick, non-surgical procedure. In this stage of the process, your doctor may prescribe progesterone and/or estrogen supplements.

Progesterone is a natural hormone produced by your ovaries after ovulation. It supports the lining of the uterus, making it easier for an embryo to become implanted. You might take vaginal, oral, or injectable progesterone, or a combination of different forms. These are some common progesterone medications:

Watch out for the following common progesterone side effects:

Soreness or swelling at the site of injection, if taking progesterone injections

Vaginal itching or burning and yeast infection, if taking suppositories

Progesterone injections may also cause hard welts at the site of injection, though this is a less common side effect.

Estrogen is also a natural hormone that thickens the uterine lining. In IVF, estrogen is used to help the body prepare for implantation, often in the form of estradiol topical patches. The following side effects may occur. Consult with your doctor if you have any concerns.

Redness or irritation in the skin covered by the patch

Constipation, bloating, or stomach cramps  

Cold symptoms (stuffy nose, sinus pain, or sore throat) 

The IVF medication schedule is precisely timed. To learn more about how these medications will be used in the context of your cycle, read our blog on the sequence of fertility medications in the IVF process: IVF Medications: Schedule and Side Effects Explained

Prenatal vitamins can help put your mind at ease even before pregnancy

Taking simple prenatal vitamins is one of the most effective ways to ensure that you have the nutrients you need to nourish your baby throughout your pregnancy. It’s never too early to start taking them, and by beginning early, you can ensure that your body has the key vitamins and minerals needed during the earliest stages of fetal development. 

Read What to Look for in a Prenatal Vitamin to learn more.

We’re with you at every step of your fertility journey

Starting fertility medications may feel stressful, but you’re never alone in your journey. Alto’s dedicated fertility team will work with your physician to ensure your treatment plan is followed properly. And our fertility pharmacists are always available to answer any questions or walk you through your first injections. To learn more, visit us at alto.com/fertility or reach out via phone, text or the app.

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.

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Fertility treatments are complicated. From managing deliveries, navigating insurance, to understanding your medication plan — we’re here to lighten your load.

A partner on your fertility journey.

We’ve supported more than 30,000 patients.

On your schedule

On your side

Here for you, anytime

We’re here to guide you.

Everything you need. Exactly when you need it.

“Our team is dedicated to providing fertility medications at a better cost, working tirelessly behind-the-scenes to handle insurance and help you enroll in financial assistance programs.”

"First time injecting? Nervous about needles? Our video injection guides walk you through everything, step by step."

FAQs

Do you carry the fertility medications I need?

How much will my fertility medications cost?

Does Alto work with my fertility benefits program?

Does Alto offer any financial assistance?

Tell your clinic you'd like to use Alto.

A partner on your fertility journey.

We’ve supported more than 30,000 patients.

On your schedule

On your side

Here for you, anytime

We’re here to guide you.

Everything you need. Exactly when you need it.

“Our team is dedicated to providing fertility medications at a better cost, working tirelessly behind-the-scenes to handle insurance and help you enroll in financial assistance programs.”

"First time injecting? Nervous about needles? Our video injection guides walk you through everything, step by step."

From Our Blog

Fertility Medications 101

Two Women Share Their Egg Freezing Journeys

Rev. Dr. Stacey L. Edwards-Dunn on Her Mission To Improve Black Fertility Care

A Guide to LGBTQ+ Family Building

IVF Medications: Schedule and Side Effects Explained

What to Consider When Selecting a Fertility Pharmacy

FAQs

Do you carry the fertility medications I need?

How much will my fertility medications cost?

Does Alto work with my fertility benefits program?

Does Alto offer any financial assistance?

Tell your clinic you'd like to use Alto.