An intrauterine device (IUD) is one of the most popular and effective forms of birth control, and the chances of getting pregnant with an IUD are very low. That's because it has a 99.7% efficacy rate, says Lanalee Araba Sam, M.D., an OB-GYN in Ft. Lauderdale, Florida. "Very, very few women with one will become pregnant," she notes. "But I always tell my patients that someone on this planet is that one-in-a-million exception. There are instances where someone becomes pregnant with an IUD in place." Show
Here's what you need to know about the symptoms of pregnancy with an IUD and the complications that can emerge if this unlikely outcome happens to you. flocu/ShutterstockWill I Get My Period With an IUD?Typically, one of the first signs of pregnancy is a missed period. But if you have an IUD, you may not be able to rely on that sign alone. Cristina Perez, M.D., an OB-GYN at the Women's Specialists of Houston at Texas Children's Pavilion for Women, explains that about 25% of menstruating people stop having their period while on Mirena (a type of IUD that uses the hormone progesterone to prevent pregnancy). The other type of IUD, ParaGard, relies on copper to prevent pregnancy. "ParaGard has no hormones," Dr. Perez explains, so if you're using it, you should still be getting your period as long as you're not pregnant. Either way, if don't get your period as expected and you could be pregnant, it's a good idea to contact your doctor and take a pregnancy test, just in case. What are the Signs of Pregnancy With an IUD?Pregnancy with an IUD typically has the same symptoms as a normal pregnancy, including breast tenderness, nausea, and fatigue. If you're experiencing symptoms of early pregnancy and have missed your period, take a pregnancy test and contact your health care provider. It's important to catch an IUD pregnancy early because of certain health concerns. At-home pregnancy tests, while very accurate when used after a missed period, can't detect a pregnancy as early as a blood test in your doctor's office or lab, so your provider may want you to come in for testing to be sure. Are There Any Risks of Pregnancy With an IUD?An IUD pregnancy comes with certain risks and complications. "You're 50% more likely to miscarry if the IUD is left in place, so the recommendation is to let the pregnancy continue and remove the IUD," says Dr. Sam. But it's important to note that you're still 25% more likely to miscarry even if the IUD is removed, so your doctor will want to monitor any IUD pregnancy closely. Getting pregnant with an IUD also comes with a higher risk of ectopic or tubal pregnancy, in which the fertilized egg implants somewhere outside the uterus (usually the fallopian tubes). Ectopic pregnancies are not viable and can be life-threatening for the pregnant person, so they need to be treated quickly. Your doctor will diagnose ectopic pregnancy with blood tests, pelvic exams, and ultrasound. If your pregnancy is ectopic, it will be treated with medication or surgery. What About Getting Pregnant After Removing an IUD?Research shows that fertility returns quickly after the removal of an IUD, assuming there are no underlying fertility concerns. (That's good news if you want to get pregnant—and fair warning if you don't!) If you have decided you want to try to conceive, give your OB-GYN a call to have your IUD removed and plan a preconception visit. Some doctors recommend waiting three months after removing an IUD to start trying to conceive to give your body time to bounce back to its usual menstrual cycle. Waiting can also help you get a sense of your cycle and fertile window and give you time to plan and get some healthy habits in place. But according to Dr. Perez, there's no medical need to wait: "You can ovulate and get pregnant the next month!" So, if you're ready to become a parent and don't want to wait, you can start trying the very first cycle after your IUD has been removed. Yes, you can get pregnant while using an IUD — but it’s rare. IUDs are more than 99 percent effective. This means that less than 1 out of every 100 people who have an IUD will become pregnant. All IUDs — hormonal, non-hormonal, or copper — have a similar failure rate. Read on to learn why this happens, your options for emergency contraception, when to take a pregnancy test, and more. In a small number of people — between 2 and 10 percent — the IUD can slip partly or completely out of the uterus. If this happens, you can get pregnant. You might not realize the IUD has fallen out of place. In some cases, pregnancy can happen because the IUD hasn’t started to work. The copper IUD, Paragard, protects against pregnancy immediately. But hormonal IUDs, such as Mirena and Skyla, can take up to seven days to become effective. You could get pregnant if you have sex without a condom or other form of protection during this window. You may also experience IUD failure if the IUD has been in place for longer than the manufacturer recommends. Although one 2015 study found that Mirena may protect against pregnancy for a full year after its FDA-approved expiration date, more research is needed to confirm this finding. If you suspect that your IUD has failed, talk to a doctor or other healthcare provider about using emergency contraception (EC).
Your provider may recommend one of the following options: Hormonal pillsAs a rule of thumb, hormonal EC is most effective when taken within 72 hours of birth control failure. However, you can still take hormonal EC for up to five days afterward. You can purchase EC pills over the counter at your local pharmacy. If you’re insured, you may consider calling your doctor to get a prescription. EC is considered preventive care, so you may be able to fill your prescription for free. If you don’t have insurance, you may have access to a financial assistance program. Copper IUDIf you have a hormonal IUD and suspect that it’s failed, talk to your doctor about switching to a copper IUD. The copper IUD can prevent pregnancy if it’s inserted within five days of birth control failure. The copper IUD can be left in for up to 10 years. As with EC pills, the copper IUD may be available at a reduced rate through your insurance plan. If you don’t have insurance, you may have access to a financial assistance program. Some birth control clinics will offer services even if you can’t pay. If the pregnancy develops in your uterus, you may notice typical pregnancy symptoms, such as:
Some of these symptoms — like cramping, spotting, and missed periods —can be similar to the side effects caused by your IUD.
Having an IUD in place may be slightly more likely to result in an ectopic pregnancy. This occurs when the embryo implants outside of your uterus. Symptoms of an ectopic pregnancy include:
An ectopic pregnancy is considered a medical emergency, so seek immediate medical attention if you’re experiencing any of these symptoms. If you think you might be pregnant, take a home pregnancy test. These tests are available over the counter (OTC). You can take an OTC test on the first day of your missed period. If your IUD has caused your periods to be irregular — or to stop completely — you should wait to one to two weeks after you suspect your IUD failed to take an OTC test. These tests are almost 99 percent accurate. In most cases, a negative result means that you aren’t pregnant. If you’re experiencing unusual symptoms or suspect that the test isn’t accurate, see a doctor. If the test is positive, make an appointment with an OB-GYN or other healthcare provider. They’ll confirm the results with a urine or blood test and discuss next steps. Your doctor will first double-check that you’re pregnant with a urine or blood test. Pregnancy tests check for human chorionic gonadotropin. Your body only produces this hormone when you’re pregnant. Your doctor will then do a pelvic exam. If your IUD string is visible, your doctor will remove the IUD. If your IUD string isn’t visible, they’ll perform an ultrasound to help locate your IUD. They may need to use a cytobrush or other tool to aid in removal. Current guidelines suggest that the IUD should be removed before the end of the first trimester. Removing the IUD after this point may result in complications for both the person carrying the pregnancy and the pregnancy itself. You should have the IUD removed regardless of whether you plan to keep or terminate the pregnancy. An ultrasound will also help your doctor determine if the pregnancy is healthy or if there are problems, such as ectopic pregnancy. If it’s ectopic, your doctor will recommend medication or surgery to remove the embryo. The exact treatment depends on the embryo’s location and overall development. IUD pregnancies are slightly more likely to be ectopic, or occur outside of the uterus. Ectopic pregnancies sometimes form in the fallopian tubes. If the pregnancy isn’t removed, the tubes can burst and cause life-threatening bleeding. An ectopic pregnancy that occurs outside of a fallopian tube — in the cervix, for example — is unlikely to grow without endangering your overall health. Other risks associated with IUD pregnancies include:
It’s also possible that exposure to the hormones in certain IUDs could affect the pregnancy. There have been reports of congenital abnormalities in live births. For example, exposure to increased levels of progestin has been linked to “increased masculinization of the external genitalia” in female fetuses. You’ll have to terminate the pregnancy if it’s ectopic. An embryo growing outside the uterus can’t survive. There’s also significant risk to the mother’s health in an ectopic pregnancy. Doctors can terminate the pregnancy in one of two ways.
If the pregnancy is in your uterus, you can decide whether you want to have an abortion. You can take the abortion pill before week 10 of pregnancy. Medical abortion is available at or after week 10 of pregnancy. Depending on where you live, you’ll need to have the abortion done before your 20th to 24th week of pregnancy. Abortion laws are more restrictive in some states than others. If you suspect that your IUD has failed, call your doctor or other healthcare provider right away. You may be able to take Plan-B or another form of EC to prevent pregnancy. If it’s too late to take EC, your provider will administer an in-office test to determine whether you’re pregnant. Once you know, you and your doctor can discuss your options going forward. How would you know if pregnant on IUD?Pregnancy with an IUD typically has the same symptoms as a normal pregnancy, including breast tenderness, nausea, and fatigue. If you're experiencing symptoms of early pregnancy and have missed your period, take a pregnancy test and contact your health care provider.
Will a pregnancy test be positive with an IUD?However, no form of birth control is 100 percent effective. While rare, it's possible to become pregnant while using an IUD. Such was the case for a patient I saw in the spring of 2018. She had an IUD, and when she took a home pregnancy test, it was positive.
What to do if you think you are pregnant with an IUD?You should have the IUD removed regardless of whether you plan to keep or terminate the pregnancy. An ultrasound will also help your doctor determine if the pregnancy is healthy or if there are problems, such as ectopic pregnancy. If it's ectopic, your doctor will recommend medication or surgery to remove the embryo.
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How do you tell if you are pregnant with an IUD?
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