Background: Assisted reproductive technology (ART) has revolutionized the field of reproductive medicine, providing hope and solutions for couples facing infertility challenges. Among the various ART techniques, in vitro fertilization (IVF) has become a widely adopted approach, enabling the creation of embryos outside the human body. Objective: The aim of this study was to investigate the pregnancy outcomes in women undergoing IVF using fresh and frozen embryo transfer within the context of Pakistan’s ART practices. Materials: The retrospective cohort study design was employed, analyzing data from IVF treatment cycles data was collected from 1,200 patients visiting 3 major fertility clinics in Lahore, Karachi, and Islamabad between 2018 and 2023. Data from clinical records were collected on patient demographics, type of embryo transfer, and treatment outcomes. Fresh and frozen transfers were compared using a statistical analysis including chi-square tests and logistic regression. Results: The clinical pregnancy (58%) and live birth (50%) rates were both higher with frozen embryo transfer than with fresh (clinical pregnancy 52%, live birth 44%). In place of fresh transfers (12%), FET (10%) was associated with a lower miscarriage rate. The outcomes of the FET were significantly influenced by age and embryo quality, with patients aged over 35 years benefited more with the FET when compared with the FISH. Conclusion: Results demonstrate that FET is associated with better pregnancy outcomes as compared to fresh embryo transfer in Pakistan. This is consistent with global studies highlighting the benefit of using FET to enhance post ART success. Such results imply that FET should be widely adopted for clinical care in order to maximize patient outcomes and align with evidence-based ART protocols.