Primary infertility is denoted for those women who have not been conceived previously. There are many biological causes of infertility such as ovulatory factors, utero-tubal peritoneal factor, semen migration factor and the male factor respectively. However, comprehensive epidemiological studies on the risk factors for primary infertility are not well documented in Ethiopia in particular current study area so far. Therefore the objective of this study was to assess determinants of primary infertility and outcome among married women attending obstetrics and gynecology specialty centers at Adama Town, Oromia, Ethiopia, 2020. Methods: Institution based unmatched case control study was conducted from November 16 to December 30, 2020. A sample of 178 married women with 1:2 ratio (59: cases and 119; controls) who attended obstetrics and gynecology clinic at Adama Town were included in the study by stratified random sampling technique. Data were collected using structured interview-administered questionnaire. Then data were entered in to Epi-Info version 7 then exported to SPSS version 24 for processing and analysis. To identify determinants of primary infertility, binary logistic regression model was used. In final fitted regression model a p-value of less than 0.05 was considered to declare significance of association. Result: A total of 178 participants (59 cases and 119 controls) were included in the study making a response rate of 100%. A significant determinants of primary infertility in this study were: Rural residence [AOR]: 27.95 (7.0, 111)], Husband Engaged in High Temperature Occupation [AOR]: 18.86 (3.8, 93.4)], eating diet enriched with saturated fat [AOR]: 10.97 (3, 40.1)], not undergoing adequate sex [AOR]: 0.120 (0.03, 0.57)], Menstruation flow greater than 3 days [AOR]: 4.4 (1.17, 16.6)], Ever use contraceptives [AOR]: 0.146 (0.05, 0.405)] and Chronic pelvic pain [AOR]: 18.7 (3.6, 94)]. More than one third of cases (33.9%) reported that perceived causes of infertility were punishment from God/Allah. Conclusion and recommendation: Being Rural residence, husband engaged in high temperature occupation, eating diet enriched with saturated fat, not undergoing adequate sex, Menstruation flow greater than 3 days, Ever used contraceptives and Chronic pelvic pain were identified as determinants of women's primary infertility. Therefore we recommend all married women to take treatment of any gynecological diseases like pelvic inflammatory disease.