Can You Get Pregnant With an IUD?

An intrauterine device (IUD) is one of the most popular and effective forms of long-term reversible birth control, and the chances of getting pregnant with an IUD are very low. That's because it has a 99.7% efficacy rate, says Lanalee Araba Sam, M.D., an OB-GYN in Ft. Lauderdale, Florida.

"Very, very few women with one will become pregnant," she notes. "But I always tell my patients that someone on this planet is that one-in-a-million exception. There are instances where someone becomes pregnant with an IUD in place."

Here's what you need to know about the symptoms of pregnancy with an IUD and the complications that can emerge if this unlikely outcome happens to you.

Irregular and Missed Periods With IUDs

Typically, one of the first signs of pregnancy is a missed period. But if you have an IUD, you may not be able to rely on that sign alone. Cristina Perez, M.D., an OB-GYN at the Women's Specialists of Houston at Texas Children's Pavilion for Women, explains that about 25% of menstruating people stop having their period while on Mirena (a type of IUD that uses the hormone progesterone to prevent pregnancy).

The other type of IUD, ParaGard, relies on copper to prevent pregnancy. "ParaGard has no hormones," Dr. Perez explains, so if you're using it, you should still be getting your period as long as you're not pregnant. Either way, if don't get your period as expected and you could be pregnant, it's a good idea to contact your doctor and take a pregnancy test, just in case.

Signs of Pregnancy With an IUD

Pregnancy with an IUD typically has the same symptoms as a normal pregnancy, including breast tenderness, nausea, and fatigue. If you're experiencing symptoms of early pregnancy and have missed your period, take a pregnancy test and contact your health care provider.

It's important to catch an IUD pregnancy early because of certain health concerns. At-home pregnancy tests, while very accurate when used after a missed period, can't detect a pregnancy as early as a blood test in your doctor's office or lab, so your provider may want you to come in for testing to be sure.

Risks of Pregnancy With an IUD

An IUD pregnancy comes with certain risks and complications. "You're 50% more likely to miscarry if the IUD is left in place, so the recommendation is to let the pregnancy continue and remove the IUD," says Dr. Sam. But it's important to note that you're still 25% more likely to miscarry even if the IUD is removed, so your doctor will want to monitor any IUD pregnancy closely.

Getting pregnant with an IUD also comes with a higher risk of ectopic or tubal pregnancy, in which the fertilized egg implants somewhere outside the uterus (usually the fallopian tubes). Ectopic pregnancies are not viable and can be life-threatening for the pregnant person, so they need to be treated quickly. Your doctor will diagnose ectopic pregnancy with blood tests, pelvic exams, and ultrasound. If your pregnancy is ectopic, it will be treated with medication or surgery.

Getting Pregnant After Removing an IUD

Research shows that fertility returns quickly after the removal of an IUD, assuming there are no underlying fertility concerns. (That's good news if you want to get pregnant—and fair warning if you don't!)

If you have decided you want to try to conceive, give your OB-GYN a call to have your IUD removed and plan a preconception visit. Some doctors recommend waiting three months after removing an IUD to start trying to conceive to give your body time to bounce back to its usual menstrual cycle. Waiting can also help you get a sense of your cycle and fertile window and give you time to plan and get some healthy habits in place.

But according to Dr. Perez, there's no medical need to wait: "You can ovulate and get pregnant the next month," she says. So, if you're ready to become a parent and don't want to wait, you can start trying the very first cycle after your IUD has been removed.