It's Possible To Get Pregnant With An IUD, But Ob-Gyns Say You Really Shouldn't Lose Sleep Over It
When you use a form of birth control, you expect that it will do what it’s designed to do—that is prevent pregnancy. But no form of birth control is 100 percent effective, even the incredibly reliable intrauterine device (IUD), and that can leave you anxiety-Googling things like “pregnant with IUD symptoms” late into the night if you suspect you're showing the typical signs.
Let’s back up a sec here: An IUD is a type of long-acting reversible contraception, according to the American College of Obstetricians and Gynecologists (ACOG). It is a small, T-shaped device that’s inserted and left inside your uterus for a certain period of time—depending on the type and brand—to prevent pregnancy.
There are two main types of IUDs, per ACOG: a hormonal IUD that releases the hormone progestin into your uterus, which are approved for between three and seven years of use, and a copper IUD, which doesn’t contain hormones and can be used for 10 years.
During the first year of use, fewer than one in 100 women using an IUD or implant will get pregnant and this form of birth control is considered 20 times more effective than the pill, patch, or ring, according to the ACOG. That said, there’s a chance—a small one—that you could get pregnant even if you have one. (More on the things that can raise your risk in a moment.)
Before you freak out, know this: It’s pretty rare to get pregnant with an IUD. Still, it’s good to be informed about what could happen and what you need to do if you find yourself in this unlikely situation.
Meet the experts: Mary Jane Minkin, MD, is a practicing gynecologist and has taught at Yale University for over 41 years.
Jennifer Wider, MD, is a women's health expert and the author of The Savvy Woman Patient, The Doctor’s Complete College Girls’ Health Guide, and The New Mom’s Survival Guide.
Christine Greves, MD, is an ob-gyn at the Winnie Palmer Hospital for Women and Babies and a fellow of the American Association of Obstetrics and Gynecology.
Is it possible to get pregnant with an IUD?
Yep, it’s possible to get pregnant with an IUD. If all goes according to plan, it rarely happens. But, ya know, that's not always the case. These are a few circumstances where you could end up with an unintended pregnancy with an IUD.
IUD expulsion: Expulsion, JIC you’re not familiar with the term, is “when the IUD moves out of its place in the top of the uterus and is either pushed to the vagina or into the lowest segment of the uterus or cervix, says Kjersti Aagaard, MD, PhD, a professor in the department of obstetrics and gynecology at Baylor College of Medicine and Texas Children's Hospital. This happens in about one to three percent of IUD patients a year, she says, and is more common when the IUD is placed right after delivering a baby.
You had unprotected sex right beforehand: This is more of an issue with the copper IUD, says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine. “If you do have sex before the IUD is placed, of course the copper won't be there to prevent the sperm from making it up inside. That can lead to failure,” she says. Because of this, Dr. Minkin says, “we usually try to place IUDs during a period—it avoids these questions, and also it is usually easier to place during a period because the cervix is a bit more dilated.”
You’ve had your IUD for too long: This one is a little tricky, given that your IUD’s effectiveness is unlikely to torpedo at a set period of time. However, IUDs have only been studied for so long, which is where the recommendations on timing come into play. “The Food and Drug Administration has approved IUDs for a certain period of time,” explains women’s health expert Jennifer Wider, MD. “Beyond these time periods, there's no guarantee they will be effective.”
Okay, so how can you know if your IUD has been pushed out of place? IUDs have strings that hang down, and you can typically feel them in your vaginal canal if you reach up high enough, Dr. Wider explains. If you can’t feel those strings or if they seem to have changed in length, it could be a sign your IUD is out of place, she says. “You also might have discomfort and irregular bleeding,” says Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies.
How would you know if you're pregnant with an IUD?
The symptoms of pregnancy with an IUD are generally the same as they are for pregnancy without an IUD, Dr. Greves says. They can include the following, according to the Mayo Clinic.
A missed period
Tender, swollen breasts
Nausea
Vomiting
Increased urination
What are the risks of getting pregnant with an IUD?
A big risk is an ectopic pregnancy, which occurs when a fertilized egg grows outside of the uterus, per ACOG. Here’s the thing: It’s not that the IUD itself increases your risk of an ectopic pregnancy—it’s that, if a pregnancy were to happen, it’s more likely to have happened outside of the uterus, explains Dr. Aagaard. “Patients aren’t at increased risk for ectopic pregnancies just because they have an IUD, and IUDs don’t cause ectopic pregnancies,” she says.
Doctors will also typically want to try to remove the IUD during a pregnancy if possible, Dr. Minkin says, due to the risk of infection and complications if it stays in place.
“Studies have shown that the risk of miscarriage, preterm birth, and infection of the amniotic sac and fluid before delivery is significantly higher when IUDs are left in place during pregnancy compared to pregnancies in which the IUD is removed,” Dr. Aagaard says. “For most women whose IUD strings are visible through the cervix, we recommend removal of the IUD at the first visit.”
What should you do if you get pregnant with an IUD?
You’ll want to contact your ob-gyn ASAP, Dr. Minkin says. “Our first step will be for us to determine if it is a pregnancy inside the uterus or ectopic, and we will utilize an ultrasound to help us do so,” Dr. Aagaard says. “Next, we will look to see if the IUD is still in place and if we can see and grasp the strings when doing a speculum exam.”
How can you avoid pregnancy with an IUD?
If you have an IUD, doctors say this really isn’t something you should lose sleep over. Still, you can be extra cautious around the time of insertion, Dr. Minkin says, including having your IUD inserted when you’re on your period or using a backup method of contraception until your next period starts. You can also regularly check to make sure you can feel your string.
In general, though, experts say you should consider yourself well covered for an unintended pregnancy if you have an IUD. “IUDs are highly effective for family planning, and have very few side effects, including pregnancy,” Dr. Aagaard says. “They are a super and very safe choice for a lot of folks and families.”
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