Objective To observe the anesthetic effect of remimazolam combined with propofol in ultrasound-guided oocyte retrieval surgery. Methods A total of 145 patients who underwent elective transvaginal ultrasound-guided oocyte retrieval from July 2024 to January 2025 were selected. They were randomly divided into three groups according to the random number table method： the propofol group （Group P）， the 0.05 mg/kg remimazolam combined with 0.1 mg/kg （Group PR₁）， and the 0.1 mg/kg remimazolam combined with propofol group （Group PR₂）. All groups were intravenously infused with sufentanil at 0.1 μg/kg at first. Group PR₁ was intravenously infused with remimazolam at 0.05 mg/kg and propofol at 1 to 3 mg/kg； Group PR₂ was intravenously infused with remimazolam at 0.1 mg/kg and propofol at 1 to 3 mg/kg； Group P was intravenously infused with an equal volume of 0.9% saline and propofol at 1 to 3 mg/kg. The vital signs of the patients in the three groups were recorded at before anesthesia induction （T₀）， after successful induction （T₁）， during puncture （T₂）， 5 minutes after the start of the operation （T₃）， at the time of awakening （T₄）， and 10 minutes after awakening （T₅）. The dosage of propofol， the success rate of sedation， the MOAA/S score at 1 minute after surgery， and the time required for the PADSS score to reach ≥ 9 were recorded. The occurrence of adverse reactions （respiratory depression， hypotension， bradycardia， nausea and vomiting， hiccups） was also recorded. Results Compared with group P， group PR1 and group PR₂ had higher heart rate and blood pressure at T1 （both P < 0.05）. Compared with group P and group PR₁， group PR₂ had lower heart rate and blood pressure at T₂ （both P < 0.05）. Compared with group P， both group PR1 and group PR₂ had lower heart rate and blood pressure at T₃ （both P < 0.05）， with no statistically significant difference in SPO₂ at each time point among the three groups （P > 0.05）. Compared with group P， the propofol dosage in groups PR₁ and PR₂ was reduced （both P < 0.05）， with a higher sedative success rate （both P < 0.05）， and higher MOAA/S scores at 1 minute post-operation （both P < 0.05）； the time required for PADSS scores to reach ≥ 9 was shorter （both P < 0.05）. Compared with group PR₁， group PR₂ used even less propofol （P < 0.05） and had a higher sedative success rate （P < 0.05）. Compared with group P， the incidence of respiratory depression and hypotension was lower in both groups PR₁ and PR₂ （both P < 0.05）. There was no statistically significant difference in the incidence of nausea， vomiting， and hiccups among the three groups （P > 0.05）. Conclusion 0.1 mg/mL of remimazolam combined with propofol has a good anesthetic effect in oocyte retrieval procedures and is worthy of clinical promotion and application.