Written by Mayra A Hernandez Schulte, M.D.

The Intrauterine Device (IUD) is over 99% effective at preventing pregnancy. While pregnancy is rare with an IUD in place, it requires special management when it occurs.

Pregnancies that occur with an IUD in place have a higher chance of being ectopic, so it is important to obtain imaging (e.g. pelvic ultrasound). (1)

Studies show that intrauterine pregnancies with an IUD in place are associated with higher rates of adverse outcomes (miscarriage, vaginal bleeding, preterm delivery, infection, and placental abruption) (2) than pregnancies without an IUD in place.

IUD within the uterus:

• If the patient chooses to continue the pregnancy, and the IUD strings are seen, the IUD should be promptly removed with gentle traction. Removing the IUD reduces adverse pregnancy outcomes, though it does not eliminate them. (3)
• If the patient chooses to continue the pregnancy and IUD strings are not visualized, counsel regarding the increased risk of adverse outcomes.
• If patient chooses abortion, then the IUD may be removed at the time of surgical abortion or before medication abortion.

IUD Outside the Uterus:

• If the IUD is not seen on ultrasound, additional imaging (e.g. X-Ray of abdomen/pelvis) will be needed however, the timing of this will depend on whether or not the patient plans to continue the pregnancy.

Resources:

Your Birth Control Choices Fact Sheet

Ectopic Pregnancy Fact Sheet

IUD Fact Sheet

Copper IUD User Guide

Progestin IUD User Guide

Sources:

Li, C. Zhao, WH., Zhu, Q. et al. Risk factors for ectopic pregnancy: a multi-center case control study. BMC Pregnancy Childbirth. 2015; 15:187. https://doi.org/10.1186/s12884-015-0613-1

Kim, S., Romero, R., Kusanovic, J. et al. The prognosis of pregnancy conceived despite the presence of an intrauterine device (IUD). Journal of Perinatal Medicine. 2010; 38(1), 45-53. https://doi.org/10.1515/jpm.2009.133

Committee on Gynecologic Practice, Long-Acting Reversible Contraceptive Expert Work Group. Clinical Challenges of Long-Acting Reversible Contraceptive Methods. www.acog.org. Accessed August 20, 2021. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/clinical-challenges-of-long-acting-reversible-contraceptive-methods

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The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.