Can you become pregnant with an Intrauterine Device (IUD) in place?

Can You Become Pregnant with an IUD?

Yes, pregnancy can occur with an IUD in place, though it is extremely rare—IUDs have failure rates of less than 1% with both typical and perfect use. 1

Understanding IUD Failure and Pregnancy Risk

While IUDs are among the most effective contraceptive methods available, pregnancy can still occur in rare circumstances:

• The absolute risk of pregnancy with an IUD is extremely low, making IUDs one of the most reliable forms of contraception 1
• Failure rates are less than 1% annually for both copper and levonorgestrel-releasing IUDs 1
• When pregnancy does occur with an IUD, it represents a contraceptive failure rather than normal expected outcomes 2

Critical Concern: Ectopic Pregnancy Risk

When a woman becomes pregnant during IUD use, the relative likelihood of ectopic pregnancy increases greatly, even though the absolute risk remains extremely low due to the IUD's high effectiveness 1

• This is a crucial clinical consideration requiring immediate evaluation of any pregnancy occurring with an IUD in place 1
• The increased relative risk occurs because IUDs prevent intrauterine pregnancies more effectively than ectopic pregnancies 1

Management When Pregnancy Occurs with IUD In Situ

The IUD should be removed as soon as possible to reduce risks of spontaneous abortion, septic abortion, preterm delivery, and chorioamnionitis 3:

Immediate Actions:

• Remove the IUD by pulling gently on the strings if they are visible or if the device is in the cervical canal 3
• Removal improves pregnancy outcomes compared to leaving the device in place 3
• Women with retained IUDs face the greatest risk of adverse pregnancy outcomes, including spontaneous abortion, preterm delivery, septic abortion, and chorioamnionitis 2

When IUD Cannot Be Removed:

• If the IUD cannot be safely removed, counsel the patient about significantly increased risks and the need for close monitoring 3
• With levonorgestrel IUDs left in place, 8 in 10 pregnancies end in spontaneous abortion 3, 2
• Even copper IUD removal decreases risks but does not eliminate them to baseline levels 2

Post-Removal Monitoring:

• Instruct patients to return promptly for heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 3
• Close surveillance is essential as pregnancies complicated by IUDs carry substantial morbidity risk 4

Why Pregnancies Occur with IUDs

Several mechanisms can lead to IUD failure:

• IUD malposition or migration to the cervix or lower uterine segment reduces contraceptive efficacy 5
• Expulsion of the IUD (occurs in fewer than 5% of users, potentially higher in younger women) leaves the patient unprotected 1
• Rarely, pregnancy can occur even with properly positioned IUDs 2

Clinical Pitfalls to Avoid

• Do not assume visible strings guarantee contraceptive protection—the IUD may have partially expelled or migrated 5
• Do not delay IUD removal once pregnancy is confirmed—early removal is critical to reduce complications 3
• Do not reassure patients that retained IUDs are safe—pregnancies with IUDs in situ have substantially elevated complication rates including an 80% spontaneous abortion rate with levonorgestrel IUDs 3, 2
• Always rule out ectopic pregnancy first when pregnancy occurs with an IUD, given the dramatically increased relative risk 1