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 reproductive 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 23 October and 14 November 2023. Results: A total of 262 respondents completed the survey (53.4% response rate). Most participants (71%) had over 5 years of experience in ART laboratories and worked in medium- to high-volume centres. Key findings revealed that 88.9% preferred verbal confirmation (reading aloud) as the most effective witnessing strategy. Additionally, 76.7% emphasized the necessity of referring to documentation at all critical stages of the process to support accurate verification, 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, lack of attention during witnessing and staff shortages 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 of 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.