Getting pregnant with an intrauterine device (IUD) in place is rare — but when it happens, it is a medical emergency. The pregnancy is often ectopic (implanted outside the uterus), which can be life-threatening. Immediate medical evaluation is required to determine the location of the pregnancy and the safest next steps.
How Common Is Pregnancy With an IUD?
IUDs are one of the most effective forms of birth control. Fewer than 1 out of 100 women become pregnant in the first year of use. Hormonal IUDs (such as Mirena or Kyleena) have a slightly lower failure rate than copper IUDs (Paragard), but both are highly reliable. Most pregnancies that do occur happen because the IUD has moved out of position (expulsion) without the woman knowing. If you suspect you might be pregnant with an IUD, take a home pregnancy test and contact your doctor right away.
What Happens If You Get Pregnant With IUD? — The Two Main Risks
When pregnancy occurs with an IUD in place, two main outcomes are possible: an ectopic pregnancy or an intrauterine pregnancy with the IUD still inside. An ectopic pregnancy means the embryo implants outside the uterus, most often in a fallopian tube. This is dangerous because the growing embryo can rupture the tube and cause severe internal bleeding. Intrauterine pregnancies with an IUD are less common but still carry risks such as miscarriage, preterm birth, and infection (chorioamnionitis).
What Is the Risk of Ectopic Pregnancy With an IUD?
Research consistently shows that while IUDs lower the overall risk of ectopic pregnancy compared to no contraception, if a pregnancy occurs with an IUD in place, the chance that it is ectopic is much higher than normal. For women using a copper IUD, about 6% of IUD pregnancies are ectopic. For hormonal IUDs, the percentage may be higher — some studies report 50% or more. This is because hormonal IUDs are especially good at preventing intrauterine pregnancy, so the few pregnancies that slip through are more likely to implant in the tube. However, the absolute risk remains low because IUD pregnancies are so rare.
How Is an IUD Pregnancy Diagnosed?
If you have a positive pregnancy test and an IUD, your doctor will perform a pelvic exam and an ultrasound. The ultrasound first checks whether the IUD is still in the correct position. It then looks for a pregnancy inside the uterus. If no pregnancy is seen in the uterus, your doctor will check the fallopian tubes and ovaries for signs of an ectopic pregnancy. Blood tests for the pregnancy hormone hCG are also done. Low or slow-rising hCG levels can suggest an ectopic pregnancy. You should not wait for symptoms — ectopic pregnancies can rupture before you feel pain.
What Is the Treatment for an IUD Pregnancy?
Treatment depends entirely on whether the pregnancy is ectopic or intrauterine. If the pregnancy is ectopic, medication (methotrexate) or surgery (laparoscopy) is needed to remove the pregnancy and save the fallopian tube if possible. If the pregnancy is intrauterine and the IUD strings are visible, the standard recommendation is to remove the IUD as soon as possible. Removing the IUD reduces the risk of miscarriage and infection. If the strings are not visible and the IUD is embedded, it may be left in place or removed under ultrasound guidance depending on the situation.
Can You Continue a Pregnancy With an IUD?
If the IUD is removed early in an intrauterine pregnancy and the pregnancy continues normally, the chance of having a healthy baby is good. Some women do carry a pregnancy to term with the IUD in place, but this is not recommended. Keeping the IUD increases the risk of miscarriage (up to 50%), preterm birth, placental problems, and serious infection. Your doctor will help you weigh the risks, but in most cases, removal of the IUD is advised if it can be done safely.
What Symptoms Should You Watch For?
Common symptoms of ectopic pregnancy include sharp abdominal pain, vaginal bleeding, dizziness, or pain on one side. But some ectopic pregnancies cause no symptoms until rupture. For intrauterine pregnancies with an IUD, watch for bleeding, cramping, fever, or foul-smelling discharge — any of these could indicate infection or miscarriage. If you have an IUD and miss a period or have a positive pregnancy test, do not wait for symptoms. See a doctor immediately.
Can an IUD Cause Birth Defects?
No. Neither copper nor hormonal IUDs are known to cause birth defects if the pregnancy continues. The IUD stays inside the uterus and does not enter the developing baby’s body. However, the risks of infection and premature birth are real, and these complications can affect the baby’s health. If you continue the pregnancy, your pregnancy will be considered high-risk and you will need closer monitoring.
Frequently Asked Questions
Can you get pregnant with an IUD and not know it?
Yes. Some women have no symptoms, especially in early pregnancy. The IUD may also expel without you noticing, leaving you unprotected.
What happens if you get pregnant with an IUD and remove it?
Removing the IUD early in an intrauterine pregnancy lowers the risk of miscarriage and infection. Your doctor will do this in the office if the strings are visible.
How soon do you need to see a doctor if you think you’re pregnant with an IUD?
Immediately. Call your doctor the same day you get a positive home pregnancy test. Ectopic pregnancy can become life-threatening in a matter of hours.
Can an IUD cause miscarriage if you are already pregnant?
If the IUD stays in place, the risk of miscarriage is high — around 40–50%. Removing the IUD early reduces this risk significantly.
