Expert-based recommendations for human witnessing in assisted reproductive technology: an Italian perspective

Research Question : What are the most effective strategies for human witnessing in Assisted Reproduction Technology (ART) laboratories? Design : An anonymous survey was conducted to investigate current human witnessing practices in ART laboratories. The survey was developed based on interviews with six experts from the Scientific Committee of the Italian Society of Embryology, Reproduction and Research (SIERR), selected for their diverse backgrounds. The survey included 22 questions (Likert-scale, closed-ended, and ranking) and was disseminated online to 491 SIERR members between October 23 and November 14, 2023. Results : A total of 262 respondents completed the survey (53.6% response rate). Most participants (71%) had over 5 years of experience in ART laboratories and worked in medium-to-high volume centers. Key findings revealed that 88.9% preferred verbal confirmation (reading aloud) as the most effective witnessing strategy. Additionally, 76.7% highlighted the importance of standardized documentation at critical stages, while 63.4% emphasized all steps as critical, prioritizing high-risk phases. A preference for per-procedure witnessing shifts (53.8%) was noted, to avoid decreased attentiveness due to excessive shifts. Chaotic environments and unclear documentation were identified as significant sources of error. Importantly, 82.8% agreed that witnesses must be healthcare professionals trained in the procedures. Conclusions : Effective human witnessing in ART laboratories involves structured protocols emphasizing verbal confirmation, standardized documentation, and monitoring high-risk phases. Witnessing tasks require trained healthcare professionals, and per-procedure shift organization enhances attentiveness and reduces fatigue. These findings provide a framework for optimizing human witnessing practices, supporting procedural accuracy, and maintaining high patient safety standards in ART laboratories.