PURPOSE: This study aimed to explore the effects of urinary PAH metabolites (PAHMs) on ovarian reserve and IVF outcomes. METHODS: We included 737 women from the prospective Chongqing Environment and Reproductive Health cohort in Chongqing, China between January and September 2023. Eight urinary PAHMs were measured at three clinical time points, with the first one collected before treatment initiation (T1), the second one collected during the ovarian stimulation period (T2), and the third one collected on the oocyte retrieval day (T3). The outcome measures from electronic medical records comprised ovarian reserve indicators and IVF outcomes, such as the probabilities of mature oocytes and normal fertilization. Linear regression models, generalized linear models with negative binomial distribution, and modified Poisson regression models were utilized to evaluate the associations between individual PAHMs and the outcomes, adjusting for key confounders. Quantile G-computation regression models were used to assess the joint effects of multi-PAHMs on the outcomes. False discovery rate (FDR) correction was applied to all P values. RESULTS: Urinary hydroxyphenanthrenes were negatively associated with probability of normal fertilization, which were robust after FDR correction and in sensitivity analyses. For the geometric mean concentrations of three samples (T123), the percent change per interquartile ratio-fold increase ranged from -3.25% to -2.31%, and for the latter two (T23), the percent change ranged from -2.95% to -2.06%. Inverse associations with probability of mature oocyte were observed for 1-hydroxynaphthalene (1-OH-Nap) (third vs. first tertile: -4.09%), the summed concentrations of 1-OH-Nap and 2-hydroxynaphthalene (third vs. first tertile: -4.23%), and multi-PAH exposure (-3.36%). Conversely, 2-hydroxyphenanthrene (2-OH-Phen), the summed concentrations of 2-OH-Phen, 3-hydroxyphenanthrene, 9-hydroxyphenanthrene, and 4-hydroxyphenanthrene, and 1-hydroxypyrene were positively associated with oocyte number retrieved, with percent changes ranging from 5.17% to 6.83% (T123) and 5.52% to 8.62% (T23). CONCLUSION: This study provided evidence of associations between PAHs exposure and increased number of oocytes retrieved but decreased probabilities of mature oocyte and normal fertilization.