I’ve been reflecting on the art of decision-making, both in my clinic and in the world of startups. Just last week, a founder I had backed visited me, seeking advice about whether to continue with his current business model or to pivot. His predicament reminded me a lot of the difficult conversations I have with my IVF patients contemplating their next steps after a failed cycle. The parallels between these seemingly disparate fields are striking and offer some valuable lessons about evaluating whether to improve, pivot, or stop altogether.
In my experience, the most critical aspect of persistence is learning. Blindly pushing forward without reflection or adaptation is not a badge of honor; it’s a recipe for disaster. When I see a patient, after a failed cycle, determined to try again, I don’t just applaud their perseverance. I sit down with them to analyze what went wrong, what worked, and what we can do differently. Similarly, for startups, it’s essential to set review dates where you can assess your progress and make informed decisions before your resources run dry.
During these reviews, I encourage founders to ask themselves a few key questions. First, is the problem significant for the customer they have chosen? Second, does their solution produce a result that the customer finds valuable? Third, is the customer willing to make a commitment and return for more? Lastly, is there a feasible way to deliver the solution and acquire customers without hemorrhaging money? These questions often reveal a path forward, whether it’s sticking to the current plan with improvements, pivoting, or stopping.
Consider a case from my portfolio, Asha’s startup. Initially, they targeted distributors with their service but found resistance. However, a subset of manufacturers found the workflow indispensable. This revelation was a cue to pivot — to redefine their customer hypothesis and gather new evidence. It’s akin to when I discover that a treatment path isn’t working for a patient, prompting me to explore alternative therapies. Pivoting isn’t about flailing in all directions; it’s a strategic decision based on evidence.
However, a pivot isn’t always the answer. Sometimes, the smartest move is to stop. This isn’t about admitting defeat; it’s about recognizing that continued investment in an unviable direction wastes time and resources that could be used more effectively elsewhere. In IVF, if the chances of success are dwindling, I have to have honest conversations with my patients about their options, including stopping treatment. Similarly, in business, if repeated tests weaken the core opportunity, it might be time to preserve capital for a more promising venture.
A founder once told me that he felt like stopping would reflect poorly on his intelligence. But I reminded him, just as I remind my patients, that the success or failure of a venture is not a verdict on your worth. It’s about external factors, market dynamics, and sometimes, sheer luck. Separating your identity from your business allows you to make more rational decisions.
One of the biggest challenges is distinguishing between rejection and inconclusive evidence. If customers never had a clear offer, demand remains uncertain. But if they understood it and consistently chose something else, that’s a more telling sign. This is where clarity and honesty play a crucial role. It’s the same in medicine; if a treatment doesn’t work, we need to understand why and not just chalk it up to a misunderstood prescription.
In this journey of deciding whether to improve, pivot, or stop, I’ve learned that it’s crucial to agree on a spending boundary with co-founders in advance. This is similar to setting a treatment budget with patients. Having these boundaries ensures that you can make decisions objectively rather than letting emotions dictate choices.
Ultimately, business, much like medicine, is a process of continuous learning and adaptation. As angel investors, founders, or doctors, we must be willing to confront hard truths and make tough decisions. Whether it’s a startup or an IVF treatment, the choice to improve, pivot, or stop should be guided by evidence, not by ego or inertia.
In the end, perhaps the most surprising insight is that the courage to stop, when necessary, is as valuable as the courage to persist. It’s a nuanced skill that takes practice and humility. But when honed, it can lead to better outcomes, be it in the world of startups or in the journey of life itself.
Part of the Building Frugal Startups: Lessons from the Trenches series — read the full guide.