Abstract Study question Do air pollutants during oocyte retrieval (OPU) and frozen embryo transfer (FET) affect in vitro fertilization (IVF) outcomes? Summary answer Environmental exposure to increased concentrations of CO either on oocyte retrieval or embryo transfer day negatively influences clinical outcomes in FET cycles. What is known already Exposure to air pollution is linked to adverse perinatal outcomes and reduced fecundity, yet its effect on fertility and IVF cycles is inconclusive. Previous studies explored associations between air pollutant concentrations and IVF outcomes with conflicting results. Nevertheless, few assessed different pollutants’ effects either on oocyte retrieval or embryo transfer days on live birth rates. While Asian and American studies suggest that pollutants affect pregnancy rates, from European studies failed to show meaningful differences in live birth rates. Considering varying pollutant levels globally, we aimed to evaluate their impact on a European population’s fertility outcomes. Study design, size, duration A retrospective cohort study analysed 1960 FET cycles conducted by a university affiliated fertility center in Europe between January 2017 to December 2022. Participants/materials, setting, methods Daily average ambient concentrations of five air pollutants (PM2.5, NO, SO2, CO, and O3) were obtained from an urban air quality monitoring station on the day of oocyte retrieval and the day of FET. Tertiles (T1, T2, T3) of each pollutant served as cut-off levels. Multiple logistic regression analysis assessed associations between pollutant exposure and pregnancy outcomes, adjusted for confounders. Main results and the role of chance Overall pregnancy and live birth rates following FET were 52.55% and 40.71%, respectively. When analysis the results according to air pollutants on the day of FET, ambient exposure to CO was significantly associated with up to 36% lower live birth (T2, OR: 0.64, 95% CI: 0.49—0.84; T3, OR: 0.67, 95% CI: 0.51—0.88; both compared to T1). Higher CO concentrations on the FET day were positively associated with increased miscarriage rates of up to 75% (T2, OR: 1.75, 95% CI: 1.12—2.75; T3, OR: 1.63, 95% CI: 1.04—2.56; both compared to T1). Limitations, reasons for caution The retrospective nature of the study and the omission of various potential covariates including environmental and patient factors that could affect IVF outcomes, limit our findings. Exposure assessment exclusively considered specific IVF days, and reliance on data from one air quality station reduces accuracy. Caution advised when interpreting the results. Wider implications of the findings This study highlights the potential impact of air quality on IVF cycle outcomes. Further investigations are needed to determine vulnerable IVF cycle phases and clarify mechanisms underlying fertility impairment. Trial registration number not applicable