The impact of endometrial thickness on pregnancy rates in women undergoing IVF with donor oocytes has significant implications for public health. Successful implantation during in vitro fertilization (IVF) is crucially dependent on both a healthy endometrium and a viable blastocyst. The measurement of endometrial thickness (EMT) via ultrasound scan has emerged as a non-invasive means to evaluate endometrial receptivity. Nonetheless, its significance in clinical practice for women using donor oocytes remains unclear. This study aims to examine how endometrial thickness influences pregnancy outcomes in women undergoing IVF with donor oocytes in Makurdi, with the goal of providing valuable insights for public health action. We conducted a cross-sectional study involving 265 women who underwent IVF and embryo transfer using donor oocytes. Participants were divided into three groups based on their EMT: Group 1 (EMT < 7 mm), Group 2 (EMT between 7 - 14 mm), and Group 3 (EMT > 14 mm). Key demographic and clinical data—including age, height, weight, number of oocytes transferred, and pregnancy rates—were gathered and analyzed using SPSS version 25.0. Statistical methods included Student’s t-test for continuous variables, Pearson’s Chi-square (χ²) test for categorical data, logistic regression to control for confounding factors, and Receiver Operating Characteristic (ROC) curve analysis to evaluate the predictive value of EMT. The average age of participants was 42.4 years, with chemical and clinical pregnancy rates recorded at 75.5% and 53.6%, respectively. Notable findings include a significant association between age and clinical pregnancy rates (p = 0.008). While other factors such as parity, BMI, previous IVF cycles, hormone treatments, and embryo grading did not show a significant relationship with pregnancy outcomes but endometrial thickness demonstrated a significant correlation (p = 0.000). Specifically, pregnancy rates were lower for women with EMT < 7.0 mm (37.3%) compared to those with EMT between 7 - 14 mm (49.0%) and > 14 mm (51.7%). Logistic regression confirmed that age-adjusted EMT significantly impacts pregnancy outcomes. ROC curve analysis revealed an area under the curve (AUC) of 0.63, with an EMT cut-off value of 8.0 mm providing a sensitivity of 75.4% and a specificity of 48.8%. These findings highlight the significant influence of endometrial thickness on clinical pregnancy rates in IVF cycles using donor oocytes. While increased EMT correlates with improved outcomes, its overall predictive accuracy is limited. The results advocate for personalized approaches in IVF treatment protocols, emphasizing informed decision-making among healthcare providers and patients. Recognizing the importance of endometrial thickness in reproductive health can inform public health initiatives aimed at enhancing awareness of IVF practices among potential candidates, tailoring IVF treatments based on individual patient profiles, and promoting research into factors affecting endometrial receptivity. Ultimately, these efforts can lead to improved pregnancy rates and reproductive success in assisted reproductive technologies.