How long should an Intrauterine Device (IUD) be removed before attempting pregnancy in a female patient of reproductive age with a normal medical history?

IUD Removal Before Attempting Pregnancy

You can attempt pregnancy immediately after IUD removal—there is no waiting period required. Fertility returns to baseline immediately upon removal, and no delay is medically necessary before conception 1, 2, 3.

Immediate Return to Fertility

• Fertility is not impaired by IUD use, and conception can occur in the first menstrual cycle after removal 1, 4, 5.
• Studies demonstrate cumulative pregnancy rates of 61.5% at 3 months, 87.9% at 6 months, and 92.3% at 12 months after IUD removal, with a mean time to conception of 4.4 months 4.
• These pregnancy rates are equivalent to women who have never used an IUD, confirming that IUDs do not cause lasting effects on fertility 5.

Clinical Evidence Supporting Immediate Conception Attempts

• Both copper-containing and levonorgestrel-releasing IUDs work primarily by preventing fertilization through inhibiting sperm motility and thickening cervical mucus—mechanisms that cease immediately upon removal 1.
• Past concerns about IUD-related infertility have been definitively disproven; any historical associations between IUDs and infertility were attributable to sexually transmitted infections, not the devices themselves 1.
• The only factors that affect time to conception after IUD removal are increasing maternal age and history of pelvic inflammatory disease—not the IUD itself or duration of use 5.

Practical Management

• Remove the IUD by pulling gently on the strings when the patient desires pregnancy 1, 2.
• No backup contraception is needed after removal if pregnancy is desired 1.
• The patient can begin attempting conception immediately—the same cycle as removal 2, 3, 4.
• If the patient has been using a levonorgestrel-releasing IUD and experienced amenorrhea, counsel that normal menstrual cycles typically resume within weeks, though conception can occur before the first post-removal menses 1, 3.

Important Caveats

• Ensure the patient is up-to-date with routine cervical cancer screening per age-appropriate guidelines (typically every 3-5 years), but do not delay IUD removal to obtain Pap smear results 6.
• If the patient has a history of pelvic inflammatory disease, this may independently affect fertility, but the IUD itself does not compound this risk 5.
• Consider preconception counseling regarding folic acid supplementation and optimization of chronic medical conditions, but these do not require delaying conception attempts after IUD removal 2.