A late period, a positive test, or unusual pain while wearing an IUD... This situation generates immediate and legitimate anxiety. Can you really get pregnant with an IUD? The answer is yes, but it's rare. The failure rate of an IUD is 0,2 to 0,8% depending on the type, making it one of the most reliable contraceptives. However, when pregnancy occurs while using an IUD, the risk of it being ectopic is considerably higherApproximately 50% of IUD pregnancies are ectopic, compared to 2% normally. This article explains how to detect an IUD pregnancy, what to do if one happens to you, and how to distinguish a simple missed period from a real warning.
The main thing to remember
- IUDs are 99%+ effective, but pregnancy remains possible (0,2-0,8% failure)
- Le Copper IUD has a slightly higher failure rate (0,6-0,8%) than the hormonal IUD Mirena (0,2%)
- 50% of pregnancies with an IUD are ectopic, compared to 2% normally
- Warning symptoms: severe pelvic pain on one side + bleeding + positive test = medical emergency
- Un late period with copper IUD can have several causes (stress, irregular cycle, onset of menopause)
- If intrauterine pregnancy is confirmed, the IUD removal reduces the risk of miscarriage from 77% to 27%
Can You Really Get Pregnant With an IUD?
Yes, it's possible, but it's extremely rare. The IUD (or intrauterine device) is one of the most effective contraceptive methods available, much more reliable than the daily pill.
Failure Rates by IUD Type
Not all IUDs are created equal when it comes to contraceptive effectiveness. Here's the current scientific evidence based on clinical studies.
To put these figures into perspective, let's compare with other contraceptive methods (Pearl index in practical use):
- Contraceptive pill: 8% annual failure (8 times more than the copper IUD)
- Male condom: 15% annual failure rate
- Withdrawal: 22% annual failure rate
- Ogino Method (calculation of fertile days): 24% annual failure rate
Why the IUD Can Fail
Although rare, several situations can explain pregnancy despite an IUD in place.
- Partial or total expulsion : The IUD slips out of its optimal position in the uterus, or is expelled completely (2-10% of cases)
- Bad initial positioning : During insertion, the IUD was not correctly placed
- End of validity expired : An IUD kept beyond its period of effectiveness (3-10 years depending on the model) loses its effectiveness.
- Pre-existing pregnancy : Rare, but the IUD was inserted while a very recent pregnancy was already underway
- Uterine perforation : Exceptionally, the IUD passes through the uterine wall and ends up in the abdominal cavity
Ectopic Pregnancy: The Real Risk with an IUD
This is THE crucial point to understand. The IUD does not cause ectopic pregnancy, but if a pregnancy occurs despite the IUD, it is much more likely to be ectopic than a normal pregnancy.
Figures to Know
A published meta-analysis of more than 21,000 women established clear data on the link between IUDs and ectopic pregnancy.
The paradox of the IUD and the ectopic pregnancy
- IUD reduces the absolute risk of ectopic pregnancy in the general population, because it prevents ALL pregnancies (intra- and extra-uterine)
- MAIS If a pregnancy occurs despite the IUD, it is ectopic in 15 to 50% of cases according to studies.
- Odds Ratio of 10,63 : A pregnancy with an IUD is 10 times more likely to be ectopic than a pregnancy without an IUD.
- In the general population, only 2% of pregnancies are ectopic
Why this increased risk?
The IUD protects the uterus better than the fallopian tubes. Here's the medical explanation.
The IUD creates local inflammation in the uterus, which prevents the implantation of an embryo in the uterine cavity. It also makes it difficult for sperm to pass through.
However, if a sperm still manages to travel up and fertilize an egg in the fallopian tube, the embryo cannot implant in the uterus (because of the IUD), but can implant in the fallopian tube where the IUD has no protective effect.
Result: the IUD "filters" intrauterine pregnancies but allows proportionally more ectopic pregnancies to pass through.
Symptoms of an Ectopic Pregnancy
Ectopic pregnancy is a medical emergency. Here are the warning signs that should prompt you to seek immediate medical attention.
Urgent symptoms
- Severe, localized pelvic pain, usually on one side only
- Shoulder pain (sign of internal bleeding irritating the diaphragm)
- Abnormal vaginal bleeding, often lighter than normal periods
- Malaise, dizziness, fainting
- Positive pregnancy test + pain under IUD
- Pain that appears between 3 and 6 weeks of pregnancy
If you experience these symptoms, call 15 or go to the emergency room immediately.
Pregnant with an IUD: What are the symptoms?
The symptoms of an IUD pregnancy are exactly the same as those of a normal pregnancy. There are no particular differences between them.
Classic Signs of Pregnancy
- Late or absent period (under copper IUD only, because the hormonal IUD can already stop periods)
- Tense and painful breasts
- Morning sickness
- Unusual fatigue
- Frequent need to urinate
- Sensitivity to odors
- Light implantation bleeding (spotting)
Special Features of the Hormonal IUD
With a hormonal IUD (Mirena, Kyleena), periods are often absent or very light. This amenorrhea is normal and does not mean that you are pregnant.
The challenge of diagnosis under hormonal IUD
Without a regular period as a guide, it's harder to detect pregnancy early. If you experience unusual symptoms (nausea, breast tenderness, fatigue), even if your period is not noticeably late, take a pregnancy test.
Some women discover their pregnancy with Mirena later, sometimes at 2-3 months, due to the lack of obvious warning signs.
Late Period with Copper IUD: Should You Be Worried?
A late period with a copper IUD can cause immediate anxiety. However, there are many benign causes. Since the copper IUD is not hormonal, your cycle remains natural and therefore subject to the same fluctuations as without contraception.
Common Causes of Delay (Outside Pregnancy)
How many days should you worry about?
There is no hard and fast rule, as every cycle is unique. However, here are some helpful guidelines.
Delay of 1 to 7 days : Common and generally not serious. Stress, travel, or a simple temporary imbalance may explain it.
Delay of 7 to 14 days : Take a pregnancy test to reassure yourself, even if other causes remain possible.
Delay of more than 14 days : Mandatory pregnancy test + medical consultation if negative test to identify the cause.
Pregnancy with IUD Confirmed: What to Do?
You've taken a pregnancy test and it's positive. The first step is to seek medical help quickly to determine if you're pregnant and decide what to do next.
Step 1: Locate the Pregnancy (Urgent Ultrasound)
The most urgent thing is to determine whether the pregnancy is intrauterine (in the uterus) or ectopic (in a fallopian tube). An early ultrasound is essential.
If the pregnancy is ectopic : Medical treatment (methotrexate) or surgical treatment (laparoscopy) depending on the situation. This is a medical emergency.
If the pregnancy is intrauterine : Discussion about removing the IUD and whether or not to continue the pregnancy.
Step 2: Removal of the IUD (If Intrauterine Pregnancy)
If you want to continue the pregnancy and it is well located in the uterus, the question of removing the IUD immediately arises.
Scientific data on withdrawal
A major study compared pregnancy outcomes with and without IUD removal.
- Risk of miscarriage if the IUD is removed: 27%
- Risk of miscarriage if the IUD is left in place: 77%
- Withdrawal therefore reduces the risk of miscarriage by 50 points
- Leaving the IUD in also increases the risk of infection, premature delivery, and serious complications.
When Withdrawal Is Possible
Removal of the IUD depends on several technical factors.
- Visible threads in the cervix : Removal can be easily done in the office, generally before 12 weeks of pregnancy
- Invisible threads : The IUD has moved up into the uterus. Removal becomes more risky and is not always possible.
- After 12-14 weeks : Withdrawal becomes technically more difficult and riskier, sometimes not recommended
- Position of the gestational sac : If the embryo is implanted far from the IUD, removal is safer.
If you do not wish to continue the pregnancy
Voluntary termination of pregnancy (VTP) remains possible using an IUD, with removal of the IUD during the procedure (medical or surgical depending on the term).
Testimonials: They Got Pregnant While Using an IUD
On forums and social media, many women share their experiences of pregnancy with an IUD. Their stories demonstrate the diversity of situations.
Laura, 22 years old: "I had a copper IUD for 6 months when my breasts started to hurt a lot, just like during my first pregnancy. I took a test, it was positive. Panic. My gynecologist did an emergency ultrasound: intrauterine pregnancy, 6 weeks. He removed the IUD immediately. I was very afraid of a miscarriage in the following days, but the baby is well attached. I am now 5 months along."
Sophie, 35 years old: "With my Mirena, I hadn't had a period for 2 years. When I started feeling nauseous and extremely tired, I didn't think about pregnancy right away. My doctor had me take a test as a precaution. I was 10 weeks pregnant. The threads were no longer visible, and it was impossible to remove the IUD. They explained the risks to me. I finally gave birth at term; the IUD was in the placenta."
Marie, 29 years old: "Intense pain in my right stomach, I thought it was appendicitis. In the emergency room, positive pregnancy test, ultrasound: ectopic pregnancy with my copper IUD. Emergency surgery. My fallopian tube was removed. It was a shock, but fortunately detected in time."
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Preventing Pregnancy with an IUD
Although the risk is low, there are a few precautions you can take to further minimize the chances of pregnancy with an IUD.
Check the position of the IUD
- Follow-up ultrasound 4-6 weeks after insertion to check the correct positioning
- Monthly wire check after menstruation: insert a clean finger into the vagina and look for the two strings at the cervix
- If the wires are missing, too long or too short : consult quickly
- Annual check-up with a gynecologist or midwife
Respect the validity period
Each IUD has a limited duration of effectiveness.
Watch for Signs of Eviction
Partial or total expulsion of the IUD is rare but possible, especially in the first few months.
Signs of eviction to watch for
- Wires much longer than usual
- Sensation of a foreign body in the vagina
- Unusual pelvic pain
- Bleeding outside of periods
- Discovery of the IUD in your period protection
Frequently Asked Questions About Pregnancy with an IUD
Living Peacefully with an IUD
The IUD remains one of the most reliable contraceptives available, with a failure rate of less than 1%. If pregnancy does occur despite everything, it's exceptional but not impossible, and you haven't done anything wrong. Your body works differently, that's all. The important thing is to remain attentive to the signals it sends you without living in constant anxiety. A simple monthly check of the IUD strings and normal vigilance are more than enough.
If you have any doubts, are experiencing an unusual delay, or experience symptoms that concern you, never hesitate to take a pregnancy test or seek medical help. This isn't paranoia; it's about listening to yourself. If the test is positive or you experience intense pelvic pain, seek medical help quickly so that an ultrasound can locate the pregnancy and guide you toward the best options. You have the right to be reassured and supported, always.
Sources & Scientific References
This article is based on scientific studies published on PubMed and recommendations from learned societies.
Studies on the failure rate of IUDs
- Chi IC, et al. (1979). Copper T IUD use and ectopic pregnancy rates in the United States. Contraception. PMID: 428232
- Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Aoun J, et al. (2014). Obstetrics & Gynecology. DOI: 10.1097/AOG.0000000000000144
Studies on ectopic pregnancy and IUD
- Xiong X, Buekens P, Wollast E. (1995). IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies. Contraception. PMID: 8521711
- Meirik O, Nygren KG. (1980). Ectopic pregnancy and IUDs; incidence, risk rate and predisposing factors. Acta Obstetricia et Gynecologica Scandinavica. DOI: 10.3109 / 00016348009155422
- Resta C, et al. (2021). Ectopic Pregnancy in a Levonogestrel-Releasing Intrauterine Device User: A Case Report. Cureus. PMID: 36875246
- Li C, et al. (2015). Ruptured Ectopic Pregnancy in the Presence of an Intrauterine Device. Clinical Practice and Emergency Medicine. PMC6366366
- Hendriks E, Rosenberg R, Prine L. (2020). Ectopic pregnancy: diagnosis and management. American Family Physician. PMID: 32412215
Studies on pregnancy with an IUD and its outcome
- Randić L, Haller H. (1992). Ectopic pregnancy among past IUD users. International Journal of Gynecology and Obstetrics. PMID: 1358688
- Ge CX, Liu MM. (1992). Relationship between ectopic pregnancy and IUD. Shengzhi Yu Biyun. PMID: 12317373
French recommendations
- Ameli (Health Insurance). Contraception by IUD or intrauterine device (IUD). Ameli Link
- Ameli (Health Insurance). Ectopic pregnancy. Ameli Link
Note: DOIs and PMIDs provide direct access to original scientific publications.
Medical Warning: This article is for informational purposes only and is not a substitute for professional medical advice. If you experience a positive pregnancy test while using an IUD, severe pelvic pain, or any concerning symptoms, consult a doctor, gynecologist, or midwife immediately, or go to the emergency room.
