The most straightforward way to get pregnant with an IUD is to have it removed. Fertility returns almost immediately after removal, and you can start trying to conceive that same cycle. Among nearly 2,400 IUD users studied in a large 2018 review, 83% became pregnant within 12 months of removal. The IUD itself, regardless of type or how long you used it, does not cause lasting effects on fertility.
What Happens to Fertility After Removal
Once an IUD is out, your body doesn’t need a “reset period.” Ovulation can resume within days for copper IUD users, since the device never suppressed it in the first place. For hormonal IUDs, the return is nearly as fast because the hormones act locally in the uterus rather than shutting down your entire reproductive cycle the way some other contraceptives do. You can attempt pregnancy the very first month.
A 2018 review of nearly 15,000 women found that contraceptive use, including IUDs, doesn’t negatively affect the ability to conceive or delay fertility after discontinuation. That held true regardless of how many years the device had been in place. In practical terms, your odds of conceiving in any given cycle after removal are roughly the same as someone who wasn’t using contraception at all.
Steps to Take Before Removal
If you’re planning a pregnancy, a few things are worth doing before your removal appointment. Start taking a prenatal vitamin with folic acid at least one month ahead of time, since the nutrient is most critical in the earliest weeks of pregnancy, often before you even know you’re pregnant. This is the single most impactful preconception step you can take.
Your provider may suggest avoiding sex for about a week before removal. Sperm can survive in the reproductive tract for up to five days, so unprotected sex right before removal could theoretically result in conception before you’ve had a chance to confirm the device is fully out. If you want to get pregnant right away, this precaution matters less, but it’s worth knowing.
The removal itself is quick. A provider grasps the IUD strings at the cervix and pulls gently. Most people describe it as a brief cramp, similar to or milder than insertion. Taking an over-the-counter pain reliever like ibuprofen or acetaminophen beforehand can help. The whole visit typically takes just a few minutes.
If the Strings Aren’t Visible
Occasionally, the IUD strings curl up into the cervical canal and can’t be seen during a routine exam. When that happens, your provider will first use a small brush to try to locate them. If that doesn’t work, an ultrasound or X-ray can confirm where the device is sitting. In rare cases where the IUD has become deeply embedded, a minor procedure using a camera inside the uterus may be needed for removal. None of these scenarios affect your fertility once the device is out.
Can You Get Pregnant While the IUD Is Still In?
It’s rare, but it does happen. IUDs are over 99% effective, making them one of the most reliable reversible contraceptives available. Hormonal IUDs have an annual failure rate of about 0.06%, while copper IUDs fail at a rate closer to 0.5%. Still, with millions of users worldwide, that small percentage adds up to real pregnancies every year.
The most common reason an IUD fails is that it moves out of position. The device needs to sit at the top of the uterus to work properly. Several things can shift it:
- Partial or full expulsion: The uterus gradually pushes the device downward or out entirely. Full expulsion happens in fewer than 5% of users, and you may not notice it.
- Size mismatch: If the uterine cavity is too small, contractions can push the device out of place. If it’s too large (common after a second-trimester pregnancy or recent delivery), the IUD may not sit snugly enough to be effective.
- Improper placement: If the device wasn’t positioned against the top wall of the uterus during insertion, it’s more likely to shift later.
Insertions done shortly after childbirth or an abortion carry higher displacement rates because of the temporary size difference between the device and the uterine cavity.
Signs of Pregnancy with an IUD
Recognizing pregnancy while using an IUD can be tricky, especially with a hormonal one. About 20% of hormonal IUD users stop having periods entirely after the first year, so a missed period may not register as unusual. Irregular spotting is also a normal side effect, which can mask early pregnancy bleeding.
The symptoms to watch for are the same as any early pregnancy: nausea, breast tenderness, fatigue, and a positive home pregnancy test. If you notice these alongside any change in your bleeding pattern, or if you can feel the IUD strings lower than usual (or can’t feel them at all), take a test. A pregnancy test works the same way whether or not you have an IUD in place.
Risks of Pregnancy with an IUD in Place
Getting pregnant with an IUD still inside carries real medical risks, which is why early detection matters. The two biggest concerns are ectopic pregnancy and complications from the device remaining in the uterus during pregnancy.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. While IUDs dramatically reduce the overall risk of any pregnancy, when a pregnancy does occur with a device in place, the proportion that are ectopic is higher than normal. In a large European study, 21 out of 118 IUD-related pregnancies were ectopic. This is a medical emergency that requires prompt treatment.
If the pregnancy is in the uterus, the next question is what to do about the IUD. Leaving it in place is associated with a 48% to 77% rate of miscarriage and a 7% to 25% rate of preterm delivery. Removing the IUD early in pregnancy significantly improves those numbers. The best available evidence shows miscarriage rates drop from about 54% to 20%, and preterm delivery rates fall from roughly 17% to as low as 4% when the device is taken out early. These rates still don’t match a pregnancy that started without an IUD, but they’re a substantial improvement. Removal is typically done if the strings are still accessible, using ultrasound guidance to confirm the device’s location.
Maximizing Your Chances After Removal
Once the IUD is out, the standard advice for conceiving applies. Track your cycle to identify your fertile window, which typically spans the five days before ovulation and the day of ovulation itself. Ovulation predictor kits, basal body temperature tracking, and cervical mucus changes can all help pinpoint timing.
Most couples under 35 who have regular, well-timed intercourse conceive within six months. The 83% success rate at 12 months from the IUD-specific research lines up closely with general population averages, which reinforces that the device doesn’t leave any lasting imprint on fertility. If you’re over 35, or if you haven’t conceived after six months of trying, it’s reasonable to check in with a provider to discuss next steps. The delay, if there is one, is almost certainly unrelated to the IUD itself.