This chapter deals with understanding of in vitro development of human oocytes and highlights the gaps that need to be bridged to achieve a complete in vitro growth (IVG) system. Female reproductive function requires cyclical development and maturation of ovarian follicles on a background of continuous activation from the pool of primordial follicles. In the clinical setting progress has been made with the ability to apply in vitro maturation (IVM) techniques to immature human oocytes with subsequent in vitro fertilization (IVF) of these oocytes leading to pregnancy and live births. In humans quiescent primordial follicles are continuously activated to grow and this is independent of physiological status. Cortical strip culture removes follicles from the in vivo endocrine and paracrine processes regulating growth rate. Culture systems support the development of isolated human follicles. The ultimate aim of a system supporting follicle growth is to produce competent epigenetically normal oocytes.