How do I use fetch_feed() to pull in a large number of posts?

It sounds like your source feed is showing only 10 posts. So, regardless of what you pit for get_item_quantity, only 10 posts will show, max.

If you’re pulling posts from a WordPress site, you can adjust how many posts are included in the RSS feed in Settings -> Reading.

Change this value: “Syndication feeds show the most recent”