Objective: To investigate the predictive value of clinical characteristics combined with intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters for early pregnancy outcomes in patients undergoing frozen-thawed embryo transfer (FET). Methods: This prospective study enrolled 70 infertile women who underwent in FET at our reproductive center between December 2023 and January 2025. All participants underwent standardized pelvic non-contrast MRI on the day of embryo transfer. Clinical and laboratory indicators, conventional MRI features, and IVIM-DWI parameters were collected. IVIM-DWI parameters (diffusion coefficient D, pseudodiffusion coefficient D*, and perfusion fraction f) were extracted using FireVoxel software, with histogram data generated via SPSS. Student’s t-test, Pearson’s chi-square test, or Fisher’s exact test were employed to compare differences in clinical characteristics, MRI features, and IVIM-DWI parameters between the successful pregnancy group (n=42) and the non-pregnancy group (n=28). The receiver operating characteristic (ROC) curve was utilized to assess the diagnostic value of each parameter, with the area under the curve (AUC) and DeLong test serving as evaluation metrics.Results: The successful pregnancy group exhibited a higher proportion of high-quality embryos compared to the non-pregnancy group [32 (76.2%) vs. 13 (46.4%%), P=0.011] The junctional zone Dmean was significantly higher in the successful pregnancy group [45.233 ± 7.930 vs. 41.223 ± 6.369, P=0.029]. ROC analysis revealed that embryo quality (high-grade embryos) predicted pregnancy success with an AUC of 0.65 (sensitivity 53.6%, specificity 73.2%), while junctional zone D*mean achieved an AUC of 0.68 (sensitivity 73.8%, specificity 67.9%). The combination of embryo quality and junctional zone D*mean demonstrated superior predictive efficacy (AUC=0.73, sensitivity 82.1%, specificity 60.0%). Conclusion: IVIM-DWI enables noninvasive assessment of microcirculatory perfusion characteristics of FET patients. Combining embryo quality with junctional zone D*mean enhances the prediction of early pregnancy outcomes.