How to make big decisions when dealing with infertility

Throughout infertility we are often faced with the kind of decisions that are life changing.  Life changing decisions for the more fertilely inclined will probably involve: whether or not to get married, which house to buy, where their next holiday destination will be, what career to choose, whether to stay or quit a job, and of course, the classic – whether they should tell their best friend that their partner is cheating on them.

For us infertiles it might also include whether or not to re-mortgage the house to pay for another round of IVF treatment, adoption, surrogacy or a.n.other expensive treatment, whether to undertake genetic testing of embryos, which body part to sell for the exuberantly priced hormonal medications we have to buy or whether to terminate a pregnancy to save our own lives.

Ok so I might have trivialised the decisions fertile people make (Please don’t take offense!), but I think you get my point.  Making decisions throughout the process is tough.  Fortunately for me, this is my line of business…I help the military make tough decisions, whether it is on operations or in peace time, I help them to see the wood for the trees.

So there are a few of the more simple techniques that I can show you that you might be able to use to help you when you get stuck in a rutt.  They are also useful to work through with your partner.  In-fact, it is is even better if you do work them through with your partner (or your BFF, sister or other close relative).  Getting an outsider’s perspective from someone who you trust can be helpful (obviously you don’t have to listen to them :-)).

I’ll order the techniques in difficulty, starting with the easiest first…


  1. Take out a large blank piece of paper and write at the top of your paper the dilemma you are trying to resolve.  For example. Take methotrexate treatment to terminate suspected ectopic pregnancy.
  2. Draw three columns down the page, each with the heading: Plusses, Minuses, Interesting.
  3. Start with the Plusses column.  Think about what the likely positive outcomes would be if you took the action.  Write each point down with a plus sign”+”.
  4. Next think about the likely negative consequences if you took the action. Write each point down with a negative sign “-“.
  5. You may also write down things that are interesting about taking this action – these might be outcomes that you are simply unsure of what the future might hold.  Write each of these down with a question mark “?”.
  6. Simultaneously get your partner to follow the exact same process.  Make sure they write what they feel, not what they think you want them to write!!!  This is a time for honesty.
  7. Now compare your lists and talk about the differences you might have and why.  If you don’t understand something on each other’s list then use the couple’s validation technique (described here) to help you explore each other’s feelings.  It is important to explore your differences and understand why they might exist.
  8. Hopefully a conclusion will fall out of this list writing.  If it doesn’t, then the dilemma you are facing is probably too complex for this technique, you may want to try another approach.


This is one of my favourite techniques!  You can do this on your own or with your partner, or as many other people as you like (ideally no more than 6 people otherwise it gets a bit chaotic!)  This technique makes you think with 6 different perspectives and helps you to organise your thoughts.  Edward De Bono who created this technique says:

“The main difficulty of thinking is confusion”.

He is quite right, and this technique helps to overcome a lot of the confusion in our minds.


  1. I like to have 6 separate blank pieces of paper ready. 1 for each of the 6 hats.
  2. Take your first sheet of paper, and write at the top: THE WHITE HAT – FACTS & INFORMATION.  The white hat makes you think about data and information.  It is used to record information that is currently available and to identify information that may be needed to help with your decision.  I.e. questions you may need to ask your medical practitioners.  Now think about all the facts you have about the problem you are facing.  For example, costs $$, available budget $$, dates, times, who is involved, who is not involved – any other facts or information you may have.  Write all these down.  Don’t forget to add any questions you may have that you simply do not know the facts of at that very moment – this is important!  Once you have run out of facts and information…move onto the next step.
  3. Take your second sheet of paper, and write at the top:  THE RED HAT – FEELINGS.  The red hat is associated with feelings, intuition and emotion.  this hat allows people to put forward their gut feelings without justification or prejudice.  Now write down your gut feelings you may have.  For example: “This drug is going to kill my immune system so I know I’m going to be sick for a long time after I take this injection. I don’t want to be sick anymore, I’m sick of being sick”.  Once you captured your feelings move onto the next step.
  4. Take your third sheet of paper, and write at the top: THE YELLOW HAT – BENEFITS.  The yellow hat is for a positive view of things.  It looks for benefits in a situation.  This hat encourages positivity even with people who tend to be more critical.  Now write down all the benefits you can think of.  Try to see the positive light when ‘wearing’ this yellow hat.  Once you have run out of positivity (!!) move onto the next step.
  5. Take your fourth piece of paper, and write at the top: THE BLACK HAT – CAUTIONS.  The black hat relates to caution.  It is used for critical judgement.  Sometimes it is easy to spend a lot of time focusing on this hat.  Now write down all the issues or downsides you can think of.  It is often easy to be the critic.  So for every negative, try to match it with a positive (using the yellow hat list and add to the yellow hat list if you need to).  Once you have finished being negative, move onto the next step.
  6. Take your fifth piece of paper, and write at the top: THE GREEN HAT – CREATIVITY.  The green hat is for creative thinking and generating new ideas.  This is your creative thinking cap.  Review your list so far.  Try to think about how you might want to overcome some of the negatives on your list – think creatively!!  You could try writing something crazy or wacky down to start with, then try to turn that crazy idea to something more realistic.  This can be difficult to do on your own!  Get some thoughts from other people!!  It is important at this stage to not immediately put down any idea your partner may make.  All ideas are good ideas when ‘wearing’ the green hat.  When you are ready move onto the final step.
  7. Take your sixth and final piece of paper, and write at the top: THE BLUE HAT – CONTROL.  The blue hat is the time to think some more about the thinking you have just done!  The blue hat reviews, summarises, concludes and makes decisions.  Now is the time to review your other 5 sheets of paper, add any last final ideas (it is OK to go back and look for any gaps in any of your 5 hats)…and time to discuss with your partner, similarly to the +, -, ? technique resolve differences in opinions and make some decisions.

Hopefully this technique will help you consider all sides of an argument and help you find some alternate points to your specific dilemma you may never have considered before.  The thing I love about this technique is that you can do this with your partner without worrying about ending up arguing.  Only negative things can be said when wearing the black hat…!!!  Use that to help you get things out on the table.  You can download a blank template here: But I would highly recommend doing the YELLOW HAT BEFORE THE BLACK HAT!!! Sometimes you can do the BLACK HAT before the YELLOW HAT, but it really is up to you 🙂

It is simple once you have done it once, and after you remember the 6 hats, you can apply this as a mental model to any decision you want to make.


This isn’t really a formal technique per se, but it is something I came across a while ago when I was making a decision about whether or not to take methotrexate to terminate my suspected ectopic pregnancy.


I used this notepad to help me make a decision whether or not to take methotrexate

I bought a pad of paper that had blank lines to fill in anytime you want to make a decision.

decision blank

It nicely mixes up the two techniques I have already explained, and it is quite funny.  You can buy these ‘Knock Knock’ notepads from amazon here.

OK this post is long enough already….I’ll write about some more decision making techniques another day 🙂

4 thoughts on “How to make big decisions when dealing with infertility

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