This chapter reviews methods that have been in practice for the evaluation of follicle culture integrity and points out the strengths and deficiencies of these methods. The traditional array of biomarkers for the ovarian follicle has emphasized endocrine performance, especially as related to the biosynthesis and secretion of estradiol. The link between DNA damage sensing and repair is fast becoming a major determinant in the assessment of follicle integrity as it relates to both somatic and germ cell components, and these assays have introduced a range of sensitivity and precision that will materially advance the field of follicle culture. The evaluation of follicle integrity for future applications in fertility preservation requires changes in our conceptual and technological approaches to this problem. The emphasis dictated by the need to obtain healthy oocytes of high developmental competence warrants conceptualizing folliculogenesis as an oocentric process.