Getting pregnant with an IUD is rare, but it happens to roughly 1 in 100 women over the course of a year. If you suspect it’s happened to you, the most important first step is confirming the pregnancy and seeing a healthcare provider quickly, because the location of the pregnancy needs to be determined as soon as possible. Pregnancies with an IUD carry higher risks than typical pregnancies, but outcomes improve significantly when the IUD is removed early.
How Pregnancy Happens With an IUD
Both copper and hormonal IUDs are among the most effective contraceptives available, but no method is 100% effective. The copper IUD has a first-year failure rate between 0.5 and 1.0 per 100 women, with a cumulative rate of about 2.2 per 100 women over 12 years of use. Hormonal IUDs have similarly low but nonzero failure rates. When failure does occur, it’s sometimes linked to a device that has partially shifted out of position without the user noticing.
Recognizing the Signs
The tricky part is that early pregnancy symptoms can look a lot like normal IUD side effects. Missed periods, spotting, cramping, breast tenderness, nausea, and fatigue are all possible signs, but if you have a hormonal IUD, you may already experience irregular periods or no periods at all. That overlap can delay recognition by weeks.
If something feels different from your usual pattern, especially new nausea, unusual spotting, or breast changes, take a home pregnancy test. Modern urine tests are accurate enough to detect pregnancy within days of a missed period. If the test is positive, contact your provider that same day or the next. Timing matters here more than it does in a typical pregnancy.
Why Ectopic Pregnancy Must Be Ruled Out First
The first thing your provider will do is check whether the pregnancy is inside the uterus or somewhere else, most commonly a fallopian tube. This is called an ectopic pregnancy, and it’s a medical emergency. IUD users who do become pregnant have a roughly 3.6 times higher relative risk of ectopic pregnancy compared to the general population. The CDC specifically recommends evaluating for ectopic pregnancy whenever a pregnancy is discovered with an IUD in place.
An ultrasound is the standard tool for confirming location. If the pregnancy is ectopic, it cannot continue and requires immediate treatment, either with medication or a minor procedure. Symptoms of ectopic pregnancy include sharp pain on one side of the lower abdomen, dizziness, shoulder pain, or heavy vaginal bleeding. If you experience any of these before getting to a provider, go to the emergency room.
IUD Removal Improves Outcomes
If the pregnancy is confirmed inside the uterus, the next decision is whether to remove the IUD. The American College of Obstetricians and Gynecologists is clear on this: if the IUD strings are visible or the device is within the cervix, it should be removed. Your provider can usually do this with a gentle pull on the strings, similar to a routine removal.
The data strongly supports early removal. A 2025 meta-analysis comparing outcomes found that removing a copper IUD reduced the risk of miscarriage by about 71% and cut the incidence of bleeding during pregnancy by 58%, compared to leaving it in place. Those are large differences. Preterm delivery rates, interestingly, were similar whether the IUD was removed or retained.
Leaving an IUD in place during pregnancy raises the stakes considerably. A systematic review published in the Canadian Medical Association Journal found that retained IUDs were associated with spontaneous miscarriage rates of 48% to 77%, preterm delivery in 7% to 25% of cases, and increased risks of infection, premature rupture of membranes, and placental abruption. Infection of the amniotic fluid is one of the most serious complications and can become life-threatening if untreated.
When the Strings Aren’t Visible
Sometimes the IUD strings have retracted into the uterus or the device has migrated. In these cases, your provider will use ultrasound to locate the IUD. If it can’t be found at all, it may have been expelled without you noticing, or in rare cases, it may have perforated the uterine wall. When the IUD is inside the uterus but the strings can’t be reached, removal becomes more complex, and your provider will weigh the risks of an attempted removal against the risks of leaving it in place.
What About the Baby’s Development?
One of the biggest concerns for people who want to continue the pregnancy is whether the IUD, particularly a hormonal one releasing levonorgestrel, has harmed the developing embryo. The available evidence is reassuring on this point. Research on pregnancies that occurred with IUDs in place found no consistent pattern of fetal abnormalities. In one study of 10 IUD pregnancies, three were carried to term, and the researchers concluded that once an embryo establishes a firm attachment in the first weeks, the pregnancy typically continues normally.
The hormones released by a hormonal IUD act locally within the uterus rather than circulating through the entire body the way oral contraceptives do. This localized action appears to limit systemic exposure to the developing pregnancy. While no study can guarantee zero risk, the current evidence does not show that hormonal IUD exposure causes birth defects.
If You Don’t Want to Continue the Pregnancy
If you decide not to continue the pregnancy, the IUD will typically be removed at the same time as the procedure or shortly before. Your options depend on how far along the pregnancy is, your location, and local regulations. Your provider can walk you through what’s available to you. Early detection gives you more options and more time to make a decision, which is another reason prompt testing matters.
After the Pregnancy Is Resolved
Whether the pregnancy ends in miscarriage, termination, or a full-term birth, you’ll want to discuss contraception going forward. An IUD failure doesn’t mean IUDs won’t work for you in the future. In many cases, the failure was related to positioning rather than a fundamental incompatibility. Your provider can check placement with ultrasound after reinsertion to confirm the device is correctly positioned.
Some people prefer to switch methods after an IUD pregnancy, and that’s a reasonable choice too. The key is having the conversation before you leave the office so there isn’t a gap in protection during a fertile window you weren’t expecting.