Getting Pregnant With an IUD: What Happens Next
Finding out you are pregnant while you have an IUD (intrauterine device) in place can come as a significant shock. While pregnancy with an IUD is uncommon, it does happen — and knowing what to expect and what steps to take can help you feel more in control.
How Common Is Pregnancy With an IUD?
Both hormonal IUDs (such as the Mirena or Kyleena) and copper IUDs are highly effective forms of contraception, with failure rates of well under 1% per year when correctly fitted. However, no contraceptive method is 100% effective, and a small number of people do become pregnant each year with an IUD in place.
If you have a positive pregnancy test and still have an IUD fitted, it is important to see your GP promptly.
The First Priority: Rule Out Ectopic Pregnancy
When pregnancy occurs with an IUD in place, there is a higher relative risk that the pregnancy may be ectopic — meaning it has implanted outside the uterus, most commonly in a fallopian tube. An ectopic pregnancy cannot develop normally and is a medical emergency if it ruptures.
Your GP will refer you urgently to an early pregnancy unit (EPU) for an ultrasound scan to confirm where the pregnancy has implanted. This is the most important first step.
Go to A&E immediately or call 999 if you have:
- Severe one-sided abdominal or pelvic pain
- Shoulder tip pain
- Vaginal bleeding combined with feeling faint or collapsing
These can be signs of a ruptured ectopic pregnancy, which is a life-threatening emergency.
Should the IUD Be Removed?
If the pregnancy is confirmed to be inside the uterus (intrauterine), your doctor will usually recommend removing the IUD as soon as possible, provided the strings are visible and accessible.
Why removal is recommended: Leaving the IUD in place during pregnancy significantly increases the risks of miscarriage, preterm labour, premature rupture of membranes, and infection of the uterus. Removing the IUD early in pregnancy reduces these risks, though it does not eliminate them entirely.
The removal procedure: If the IUD strings are visible at the cervix, removal is usually straightforward and similar to a routine IUD removal — a quick procedure performed by a doctor or specialist nurse. You may experience some cramping and spotting afterwards. The procedure itself carries a small risk of miscarriage, but this risk is generally lower than the risks of leaving the IUD in place.
If the strings are not visible: Sometimes the strings retract into the uterus or cannot be seen on examination. In this case, removal is more complex and may require specialist input. Your care team will discuss your options, which may include leaving the IUD in situ and monitoring the pregnancy very closely with regular scans.
What Happens After Removal?
Once the IUD is removed, the pregnancy can continue if that is your wish, though your care team will advise close monitoring given the higher-risk nature of the situation. You will likely be offered additional early scans and more frequent antenatal appointments.
Some people choose not to continue the pregnancy in these circumstances. If that applies to you, your doctor or midwife can discuss your options in a non-judgemental way, and you are entitled to information and support whatever you decide.
Emotional Impact
Learning you are pregnant unexpectedly, especially with a contraceptive device in place, can bring a complicated mix of emotions — shock, anxiety, uncertainty, and sometimes grief if the pregnancy does not continue. These responses are valid and understandable. Your GP can refer you to counselling if you would find it helpful, and the early pregnancy unit team are experienced in supporting people through difficult and unexpected situations.
Frequently Asked Questions
Can I get pregnant with an IUD?
Yes, although it is uncommon. Both hormonal and copper IUDs are highly effective, but neither is 100% reliable. If you think you may be pregnant and have an IUD fitted, take a pregnancy test and contact your GP promptly if it is positive. Because IUD failure carries a higher risk of ectopic pregnancy, it is important not to wait and see — seek medical advice quickly.
Will IUD removal cause a miscarriage?
IUD removal in early pregnancy does carry a small risk of miscarriage, but this risk is generally considered lower than the risks of leaving the IUD in place — which include a significantly higher chance of miscarriage, infection, and preterm birth. Your doctor will explain the risks and benefits for your specific situation before any procedure. The decision is made with you, not for you.
What if the IUD cannot be removed?
If the strings are not visible or accessible, removal may not be possible without a more involved procedure. In this situation, your care team will monitor the pregnancy very closely with regular ultrasound scans and be alert to complications. They will explain what to watch out for and when to seek help urgently. Some pregnancies with a non-removable IUD in situ do progress, but the risks remain elevated throughout.
Speak to your GP or midwife for advice specific to your situation — every case is different and individual guidance is essential.
Further reading:
This article is for informational purposes only and does not constitute medical advice.
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