Error management in medicine has long been recognised as both a challenge and an opportunity. In medically assisted reproduction (MAR), the stakes are exceptionally high because professionals handle biological material of unique and irreplaceable value, namely gametes and embryos. And yet little is known about how centres manage mistakes when they happen despite the complexity of procedures and the profound responsibility carried by teams.
This prompted the ESHRE Special Interest Groups on Safety and Quality in ART and Ethics and Law to look deeper. Their joint study, now published in Human Reproduction1, offers the first broad snapshot of how MAR professionals record, report, and disclose errors. Crucially, the research also highlights where gaps remain.
The study collected 387 responses from MAR professionals. The results show that most centres keep records of both clinical and laboratory errors, usually in digital systems. But a significant minority still do not, often because no legal framework obliges them to. Near misses—the incidents that could have gone wrong but didn’t—are only systematically recorded in about half of centres, despite being among the most valuable opportunities for learning.
When it comes to reporting beyond the centre, the picture is uneven. Only a small fraction of respondents said they report all types of errors to their national competent authority (NCA). More than a quarter admitted they do not report any. For many, there is no structured system to do so, or no clear national requirement.
Transparency at the regulatory level is equally patchy: most professionals either do not know if their NCA publishes a register of adverse events, or confirmed that no such register exists. Patients too do not always receive the full picture. Just over half of respondents said their centre always discloses errors to patients. Others do so selectively, often limiting disclosure to major incidents, while moderate or minor ones are left unspoken. Only one in three centres has formal guidelines on how to disclose errors.
What does “being transparent” really mean? Transparency is not achieved by keeping a digital logbook or sending a report to the authorities. It is a cultural choice. It means fostering an environment in which staff feel safe to speak up, near-misses are not swept under the rug, and errors become shared learning moments instead of private burdens.
For MAR centres, transparency must work in three directions. The first involves internal communication among colleagues which is open and supported by regular team discussions and non-punitive responses. Another is upwards, consistent reporting to directors and regulators, enabling collective learning and system-level improvements. And the third involves outwards, honest, empathetic communication with patients, who entrust us with their most intimate hopes.
Without this threefold openness, the risk exists of errors remaining hidden, repeating themselves, and eroding trust.
The failure to report an error rarely means the problem disappears. On the contrary, it often multiplies the harm. At centre level, silence prevents the identification of systemic weaknesses and allows the same mistakes to recur. For staff, it can lead to isolation, shame, and burnout, as professionals carry the weight of errors alone. For patients, it risks breaking the fragile bond of trust that underpins every fertility treatment, and in the most severe cases, it can jeopardise safety itself.
Non-disclosure is therefore not neutral. It is a choice that undermines both professional integrity and patient confidence.
Errors in MAR are rare, and serious incidents rarer. But their consequences are amplified by the context: fertility treatment sits at the intersection of science, ethics, and deep personal vulnerability. A single mistake can have lasting repercussions on patients’ lives and on the credibility of the entire sector.
This study highlights that our community is already making important efforts. Regular staff meetings, root cause analyses, and patient disclosures are increasingly common. But it also shows that more should be done. What is still needed are harmonised definitions of error severity, standardised reporting pathways, and clear guidance on patient communication.
Perhaps the most important lesson is that error management is not about blame. It is about culture. A culture of openness transforms mistakes from sources of fear into opportunities for learning. It protects staff as much as patients, turning potential crises into collective improvements.
“To err is human”—this aphorism resonates strongly in MAR. Perfection is not possible in such a complex field. What is possible is a shared commitment: to recognise, understand, report, and learn from our mistakes. For the MAR community, the message is clear: error management is not a bureaucratic burden. By choosing transparency, we not only protect patients—we strengthen our profession and the trust placed in it.
Reference
1 ESHRE Special Interest Group Safety and Quality in ART, and Ethics and Law, Alessandra Alteri, Kelly Tilleman, Nathalie Vermeulen, Giuliana Baccino, Kenny A Rodriguez-Wallberg, Arianna D’Angelo, Theofano Bounartzi, Zdravka Veleva, Heidi Mertes ‘To err is human, also in medically assisted reproduction: a cross-sectional study on error management practices’ https://doi.org/10.1093/humrep/deaf115
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