Reply: immature oocyte proportion may or may not compromise ICSI outcomes, but methods do: a critical appraisal

Dear Editors, We thank Drs Aktoz and Sahin (Aktoz and Sahin, 2026) for their careful reading and thoughtful engagement with our work. We appreciate the opportunity to clarify methodological aspects and the scope of our findings. Our study (Sripada et al., 2025) addressed a specific clinical question: once a patient has obtained a given number of mature (MII) oocytes, does the proportion of immature oocytes predict different live birth outcomes per embryo transfer? This is distinct from asking whether patients with high immature proportions achieve lower per-retrieval success rates; a question we do not claim to answer. Many practitioners express concern that cycles yielding predominantly immature oocytes represent poor-quality cohorts, even when adequate mature oocytes are obtained. This influences patient counseling and expectations for success. Prior studies have reported similar concerns. Our data suggest that once sufficient mature oocytes are retrieved, the proportion of immature oocytes may not require modified clinical management or altered prognostic counseling. This challenges a common clinical assumption with practical implications for patient counseling.