Pregnancy with an intrauterine device (IUD) is rare but possible. According to the American College of Obstetricians and Gynecologists (ACOG), fewer than 1% of people using an IUD or implant become pregnant during the first year of use. Still, recognizing early symptoms and understanding potential risks is important if you rely on this form of long-acting contraception.
How Pregnancy Can Occur With an IUD
IUDs—hormonal and copper—are among the most effective birth control options available. They work by preventing sperm from reaching or fertilizing an egg. Even so, several circumstances can reduce their effectiveness:
Expulsion
In 1% to 3% of users each year, the IUD may shift or be expelled from the uterus. Expulsion is more likely when the device is placed immediately after childbirth. Changes in IUD string length, inability to feel the strings, pelvic discomfort, or irregular bleeding may indicate that the device has moved.
Unprotected sex before insertion
If intercourse occurs shortly before IUD placement, a person may already be at risk of pregnancy. This is particularly relevant for copper IUDs, which begin working immediately after insertion.
Extended use beyond approved duration
Each IUD is FDA-approved for a specific time frame—3 to 7 years for hormonal devices and up to 10 years for copper IUDs. Effectiveness beyond those limits has not been fully studied.
Symptoms of Pregnancy With an IUD
Pregnancy symptoms are the same regardless of whether an IUD is in place. According to Mayo Clinic, early indicators include:
- Missed period
- Breast tenderness
- Nausea or vomiting
- Fatigue
- Increased urination
Anyone experiencing these symptoms should take a home pregnancy test and contact a healthcare professional.
Potential Risks
A major concern is ectopic pregnancy, in which a fertilized egg implants outside the uterus. While IUDs do not increase the overall risk of ectopic pregnancy, any pregnancy that occurs with an IUD in place is more likely to be ectopic.
If the pregnancy is inside the uterus, clinicians usually attempt to remove the IUD. Leaving it in place increases the risk of miscarriage, infection, and preterm birth.
What to Do if You Become Pregnant With an IUD
Seek medical care immediately. An ob-gyn will confirm the location of the pregnancy—usually with an ultrasound—and check whether the IUD strings are visible and removable during a pelvic exam.
Reducing the Already Low Risk
Most people using an IUD do not need to take additional precautions. Still, clinicians recommend:
Scheduling insertion during a menstrual period when possible
Using backup contraception until the next period after insertion
Checking for IUD strings periodically
Experts emphasize that IUDs remain one of the safest and most effective long-term contraceptive options.
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