Objective Investigate the impact of propofol anesthesia on pregnancy outcomes in the fresh embryo transfer phase of in vitro fertilization (IVF). Methods A retrospective cohort study was conducted to gather clinical data from patients undergoing fresh embryo transfer cycle of IVF. The patients were categorized into two groups based on the administration of propofol: the anesthesia group and the non-anesthesia group. Propensity score matching and Multiple-factor analysis were employed to examine the impact of propofol on pregnancy outcomes. Results A total of 320 patients were included in the study, with 108 patients in the anesthetic drug use group and 212 patients in the non-anesthetic group. Following propensity score matching, 91 patients were allocated to each group, with no statistically significant differences observed in baseline characteristics between the two groups (P 0.05). The intrauterine pregnancy rate was 53.8% in the anesthesia group and 46.2% in the non-anesthesia group, with no significant variance between the groups (P=0.300). Multivariate analysis indicated that the use of propofol did not impact the intrauterine pregnancy rate (OR=1.07, 95%CI: 0.66-1.73, P=0.775). Conclusion Propofol did not significantly impact the intrauterine pregnancy rate in IVF.