Can removal of an Intrauterine Device (IUD) cause difficulty in maintaining a pregnancy?

IUD Removal Does NOT Cause Difficulty Maintaining Pregnancy—It Actually IMPROVES Pregnancy Outcomes

Removing an IUD during pregnancy significantly reduces the risk of pregnancy loss and complications; leaving it in place substantially increases risks of spontaneous abortion, septic abortion, preterm delivery, and infection. 1

The Evidence is Clear: IUD Removal Protects Pregnancy

The CDC guidelines unequivocally state that removal of the IUD improves pregnancy outcomes when strings are visible or the device can be safely retrieved from the cervical canal. 1 The concern is not that removal causes problems—it's that keeping the IUD in place creates serious risks.

Risks When IUD Remains In Place During Pregnancy

Women who retain their IUDs during pregnancy face substantially elevated risks compared to those who have them removed: 1, 2

• Spontaneous abortion (including life-threatening septic abortion) 1, 2, 3
• Preterm delivery 1, 2, 3
• Chorioamnionitis (intrauterine infection) 1, 2, 3
• Placental abruption 3
• Microbial invasion of the amniotic cavity (45.9% with IUD vs. 8.8% without) 3

A systematic review found that with LNG-IUDs left in place, 8 out of 10 pregnancies ended in spontaneous abortion. 1, 2

Benefits of IUD Removal

The CDC recommends removing the IUD as soon as possible if pregnancy occurs with an IUD in situ. 1, 4 While removal reduces risks substantially, it's important to counsel patients that risks may not decrease entirely to baseline levels of pregnancies without an IUD. 1

Clinical Management Algorithm

When IUD Strings Are Visible or Retrievable

1. Evaluate for ectopic pregnancy first 1, 4
2. Advise immediate removal of the IUD 1, 4
3. Remove by gently pulling on the strings 1, 4
4. Counsel about warning signs: heavy bleeding, cramping, pain, abnormal discharge, or fever requiring prompt medical attention 1, 4

When IUD Strings Are Not Visible

1. Perform transvaginal ultrasound to locate the IUD 1, 5
2. If intrauterine and accessible: Consider ultrasound-guided removal using alligator forceps (successful in multiple case series) 6, 7
3. If extrauterine/perforated: Obtain abdominal X-ray and consider laparoscopic removal 5, 8
4. If removal not feasible: Counsel about substantially increased risks and need for close monitoring 1, 5

Critical Pitfalls to Avoid

Do not assume removal causes pregnancy loss—this is the opposite of reality. The evidence consistently shows that removal prevents pregnancy loss. 1, 2

Do not leave the IUD in place thinking it's "safer" than removal—retained IUDs carry risks of spontaneous abortion exceeding 50% in some studies, plus serious infectious complications. 2, 3

Do not delay removal once pregnancy is confirmed—early removal provides the best outcomes. 1, 2

Special Considerations

For LNG-IUDs specifically, there is theoretical concern about fetal hormonal exposure, though whether this increases fetal abnormalities remains unknown. 1 However, the overwhelming risk is spontaneous abortion (80% when left in place), making this concern largely academic. 1, 2

Patients with cervically located IUDs require immediate removal due to pain, bleeding, infection risk, and reduced contraceptive efficacy. 4