Can an egg (oocyte) retrieval be performed while a hormonal intrauterine device (levonorgestrel IUD) is in place?

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Last updated: October 27, 2026 • View editorial policy

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Yes, egg retrieval can be performed with a hormonal IUD in place

The levonorgestrel IUD does not need to be removed prior to ovarian stimulation and oocyte retrieval, as it does not adversely affect cycle outcomes or oocyte quality. Multiple studies demonstrate that women undergoing controlled ovarian stimulation with a hormonal IUD in situ achieve comparable oocyte yields, maturation rates, and pregnancy outcomes to those without an IUD 1, 2, 3.

Evidence Supporting IUD Retention During Egg Retrieval

The most robust evidence comes from a 2024 retrospective cohort study of 4,059 oocyte freezing cycles, which found no adverse association between levonorgestrel IUDs and either oocyte yield or maturation rate in patients undergoing planned oocyte cryopreservation 1. When controlling for confounders including age, BMI, antral follicle count, and gonadotropin dosing, the presence of a hormonal IUD showed:

  • Comparable total oocyte yield across all contraceptive groups
  • No significant difference in mature (metaphase II) oocyte rates available for cryopreservation
  • No impact on clinical pregnancy or live birth rates in oocyte recipients 2

A 2018 study specifically examining levonorgestrel IUDs during ovarian stimulation confirmed these findings, showing no significant differences in total oocyte yield or mature oocyte yield when controlling for relevant clinical variables 2.

Clinical Practice Implications

The IUD can remain in place throughout the entire stimulation cycle and retrieval procedure. This approach offers several advantages:

  • Maintains contraceptive protection during the stimulation period
  • Avoids an additional procedure and associated costs
  • Eliminates the small risks of IUD removal (bleeding, infection, perforation)
  • Allows immediate contraceptive coverage post-retrieval

Case reports from egg donation programs demonstrate successful outcomes when donors retained their Mirena IUDs during treatment cycles, with satisfactory follicular development, oocyte quality, and recipient pregnancy rates 3.

Important Caveats

While the IUD does not interfere with ovarian stimulation or retrieval, be aware that:

  • The IUD provides no protection against sexually transmitted infections during the treatment cycle 4
  • If pregnancy occurs despite the IUD (extremely rare with Pearl Index 0.13), the device should be removed if strings are visible to reduce risks of spontaneous abortion and preterm delivery 5
  • Some recent data suggest prior long-term levonorgestrel IUD use may be associated with slightly thinner endometrial lining at embryo transfer, though this does not translate to worse pregnancy outcomes 6

Practical Algorithm

For patients presenting with a hormonal IUD who desire egg retrieval:

  1. Confirm the IUD is properly positioned via ultrasound during baseline assessment
  2. Proceed with standard ovarian stimulation protocols without IUD removal
  3. Perform oocyte retrieval as usual - the IUD does not interfere with transvaginal follicle aspiration
  4. Consider IUD removal only if:
    • The patient desires to discontinue this contraceptive method
    • Anatomical distortion is identified that would complicate retrieval (rare)
    • The patient becomes pregnant (remove if strings visible)

The evidence consistently demonstrates that retaining the levonorgestrel IUD during fertility preservation or egg donation cycles is both safe and practical, with no compromise to treatment outcomes.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.