Objectives To study whether the size and texture of oocytes/zygotes differ between in vitro maturation (IVM) and traditional IVF and to determine whether these affect the rate of fertilization and blastocyst development. Design Prospective case–control study. Setting Fertility clinic. Patient(s) The study involved 83 participants/cycles of IVF with intracytoplasmic sperm injection (ICSI) or IVM treatment. Intervention(s) Participants were allocated to the following groups: patients with and without polycystic ovary syndrome (PCOS) undergoing ICSI (PCOS-ICSI and Control-ICSI), and patients with PCOS undergoing IVM (PCOS-IVM). All oocytes were cultured in an Embryoscope incubator. Main Outcome Measure(s) Oocyte/zygote sizes were recorded and texture parameters of the ooplasm were analyzed using ImageJ and maZda software. Measurements were recorded at five developmental stages: sperm injection, second polar body extrusion, the first pronuclei appearance, pronuclei disappearance, and immediately before cytokinesis. Result(s) Normally fertilized PCOS-IVM oocytes were significantly larger at the sperm injection and second polar body extrusion stages, compared with both the PCOS-ICSI and Control-ICSI groups. The PCOS-IVM oocytes were significantly larger at the pronuclei disappearance stage compared with the Control-ICSI group. Oocyte texture parameters were significantly different from both other treatment groups in the early developmental stages, although these were predominantly seen when compared with the Control-ICSI group. There were no significant differences in size or texture by the final stage of immediately before cytokinesis between any of the treatment groups. Conclusion(s) This study suggests that oocyte size and texture differ in the early stages of the first cell cycle.