Hu J, Molinari E, Darmon S, et al. - Via performing this retrospective cohort study including a total of 2,690 consecutive fresh autologous oocytes obtained from women aged 41.2 ± 5.0 years between 2017 and 2019, researchers herein examined if 4 cytoplasmic granulation patterns of human metaphase II oocytes have a predictive value for in vitro fertilization outcomes. Granulation pattern was determined in every oocyte during intracytoplasmic sperm injection as fine, central, dispersed, and newly introduced uneven granulations. Fertilization outcomes (2 pronuclei [2PN], < 2PN, and > 2PN rates), pregnancy, and live birth rates for different granulation patterns at different ages were assessed as the main outcome measures. In this study, for the first time, 4 distinct cytoplasmic granulation patterns in metaphase II oocytes were demonstrated to have, largely independent of age and other variables, a predictive value for fertilization, pregnancy, and live birth outcomes in in vitro fertilization cycles of poor-prognosis patients. The highest 2PN rate was noted with fine granulation, followed by central, uneven, and dispersed granulation (91.8%, 83.9%, 77.9%, and 54.8%, respectively). Per these data, upstream ooplasm granulation patterns should be paid closer attention in terms of embryo selection.