Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

The Association Between Mature Oocyte Proportion and IVF Success: A Retrospective Analysis of 2,565 ICSI Cycles

Authors
1 Department of Histology and Embryology, Faculty of Medicine, Malatya Turgut Özal University, Malatya, Turkey
2 Department of Histology and Embryology, Faculty of International Medicine, İstanbul Medipol University, Istanbul, Turkey
3 In Vitro Fertilization Center, İstanbul Medical Park Hospital, Istanbul, Turkey
4 In Vitro Fertilization Center, İstanbul Kadıköy Florence Nightingale Hospital, Istanbul, Turkey
Abstract
Background: IVF/ICSI success depends on the proportion of fertilizable metaphase II (MII) oocytes, yet direct evidence linking mature-oocyte rate to clinical outcomes remains limited. This study aimed to assess the impact of mature oocyte rate on clinical pregnancy outcomes in a large retrospective cohort of women undergoing ICSI. Methods: A total of 2,565 women who underwent ICSI cycles at a single IVF center in Türkiye were retrospectively analyzed. Patients were stratified into three groups according to mature oocyte proportion: Group 1 (0-50%), Group 2 (51-75%), and Group 3 (76-100%). Data were analyzed per initiated ICSI cycle. Embryo transfer was performed on day 3 or day 5 post-fertilization, depending on embryo quality and patient characteristics. Logistic regression analysis was performed to assess the independent effect of mature oocyte rate on pregnancy outcomes. Statistical significance was set at p<0.05. Results: Clinical pregnancy rates were significantly lower in Group 1 (10.23%) compared to Group 2 (28.96%) and Group 3 (29.99%) (p<0.001). Live birth and implantation rates increased in the higher maturity groups (7.5% vs. 21.5% vs. 22.9% and 12.1% vs. 24.3% vs. 26.0%, respectively), whereas miscarriage rates decreased (18.9% vs. 13.4% vs. 12.8%). Logistic regression analysis confirmed that a higher mature oocyte proportion was an independent predictor of clinical pregnancy (Group 2: OR=3.4, 95%CI: 2.5-4.6; Group 3: OR=3.5, 95%CI: 2.6-4.7; p<0.001). Conclusion: This large-scale retrospective cohort analysis demonstrates that mature oocyte proportion is an important prognostic factor of IVF success. Mature oocyte proportion should be considered an essential parameter in clinical practice and patient counseling.
Keywords

  1. Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018;62:2-10.
  2. Tamrakar SR, Bastakoti R. Determinants of infertility in couples. J Nepal Health Res Counc. 2019;17(1):85-9.
  3. Jain C, Khan W. Psychosocial concomitants of infertility: a narrative review. Cureus. 2025;17(3):e80250.
  4. Adamson GD, Zegers-Hochschild F, Dyer S. Global fertility care with assisted reproductive technology. Fertil Steril. 2023;120(3 Pt 1):473-82.
  5. Lou H, Li N, Guan Y, Zhang Y, Hao D, Cui S. Association between morphologic grading and implantation rate of euploid blastocyst. J Ovarian Res. 2021;14(1):18.
  6. Krisher RL. The effect of oocyte quality on development. J Anim Sci. 2004;82 E-Suppl:E14-23.
  7. Conti M, Franciosi F. Acquisition of oocyte competence to develop as an embryo: integrated nuclear and cytoplasmic events. Hum Reprod Update. 2018;24(3):245-66.
  8. Parrella A, Irani M, Keating D, Chow S, Rosenwaks Z, Palermo GD. High proportion of immature oocytes in a cohort reduces fertilization, embryo development, pregnancy and live birth rates following ICSI. Reprod Biomed Online. 2019;39(4):580-7.
  9. Nicholas C, Darmon S, Patrizio P, Albertini DF, Barad DH, Gleicher N. Changing clinical significance of oocyte maturity grades with advancing female age advances precision medicine in IVF. iScience. 2023;26(8):107308.
  10. Moon JH, Zhao Q, Zhang J, Reddy V, Han J, Cheng Y, et al. The developmental competence of human metaphase I oocytes with delayed maturation in vitro. Fertil Steril. 2023;119(4):690-6.
  11. Wei J, Luo Z, Dong X, Jin H, Zhu L, Ai J. Cut-off point of mature oocyte for routine clinical application of rescue IVM: a retrospective cohort study. J Ovarian Res. 2023;16(1):226.
  12. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26(7):1768-74.
  13. Drakopoulos P, Blockeel C, Stoop D, Camus M, de Vos M, Tournaye H, et al. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI: how many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Hum Reprod. 2016;31(2):370-6.
  14. Magnusson Å, Källen K, Thurin-Kjellberg A, Bergh C. The number of oocytes retrieved during IVF: a balance between efficacy and safety. Hum Reprod. 2018;33(1):58-64.
  15. Wang P, Zhao C, Xu W, Jin X, Zhang S, Zhu H. The association between the number of oocytes retrieved and cumulative live birth rate in different female age strata. Sci Rep. 2023;13(1):14516.
  16. Bahadur G, Homburg R, Jayaprakasan K, Raperport CJ, Huirne JAF, Acharya S, et al. Correlation of IVF outcomes and number of oocytes retrieved: a UK retrospective longitudinal observational study of 172 341 non-donor cycles. BMJ Open. 2023;13(1):e064711.
  17. Cai Q, Wan F, Huang K, Zhang H. Does the number of oocytes retrieved influence pregnancy after fresh embryo transfer? PLoS One. 2013;8(2):e56189.
  18. Sermondade N, Sonigo C, Pasquier M, Ahdad-Yata N, Fraison E, Grynberg M. Searching for the optimal number of oocytes to reach a live birth after in vitro fertilization: a systematic review with meta-analysis. F S Rev. 2023;4(2):101-15.
  19. Datta AK, Nargund G, Wilding M, Dobson S, Campbell S. Embryo utilisation rate and transferable embryo to oocyte ratio correlate positively with livebirth rate but negatively with oocyte number: analysis of 14,156 fresh IVF/ICSI cycles. J Ovarian Res. 2025;18(1):112.
  20. Connell MT, Richter KS, Devine K, Hill MJ, DeCherney AH, Doyle JO, et al. Larger oocyte cohorts maximize fresh IVF cycle birth rates and availability of surplus high-quality blastocysts for cryopreservation. Reprod Biomed Online. 2019;38(5):711-23.
  21. Ou Z, Du J, Liu N, Fang X, Wen X, Li J, et al. The impact of low oocyte maturity ratio on blastocyst euploidy rate: a matched retrospective cohort study. Contracept Reprod Med. 2024;9(1):41.
  22. Sripada V, Sakkas D, Vaughan D, Morse B, Fouks Y. A high proportion of immature oocytes in a cycle cohort does not compromise embryo development or live birth rates after ICSI. Hum Reprod. 2025;40(12):2318-25.
  23. Veeck LL, Zaninovic N. An atlas of human blastocysts. Boca Raton: CRC Press; 2003. 286 p.
  24. Madaschi C, de Souza Bonetti TC, de Almeida Ferreira Braga DP, Pasqualotto FF, Iaconelli A Jr, Borges E Jr. Spindle imaging: a marker for embryo development and implantation. Fertil Steril. 2008;90(1):194-8.
  25. Sirait B, Wiweko B, Jusuf AA, Iftitah D, Muharam R. Oocyte competence biomarkers associated with oocyte maturation: a review. Front Cell Dev Biol. 2021;9:710292.
  26. Vitale SG, Rossetti P, Corrado F, Rapisarda AM, La Vignera S, Condorelli RA, et al. How to achieve high-quality oocytes? The key role of myo-inositol and melatonin. Int J Endocrinol. 2016;2016:4987436.
  27. Zhang Z, Wu T, Sang Q, Wang L. Human oocyte quality and reproductive health. Sci Bull (Beijing). 2025;70(14):2365-76.
  28. Kushnir VA, Frattarelli JL. Aneuploidy in abortuses following IVF and ICSI. J Assist Reprod Genet. 2009;26(2-3):93-7.
  29. Fragouli E, Katz-Jaffe M, Alfarawati S, Stevens J, Colls P, Goodall NN, et al. Comprehensive chromosome screening of polar bodies and blastocysts from couples experiencing repeated implantation failure. Fertil Steril. 2010;94(3):875-87.
  30. Bernstein LR, Treff NR. Editorial: causes of oocyte aneuploidy and infertility in advanced maternal age and emerging therapeutic approaches. Front Endocrinol (Lausanne). 2021;12:652990.
  31. Jaswa EG, McCulloch CE, Simbulan R, Cedars MI, Rosen MP. Diminished ovarian reserve is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity. Fertil Steril. 2021;115(4):966-73.