You’re staring at a plastic stick in a bathroom that suddenly feels way too small, and there are two lines. Your heart is doing that weird thumping thing against your ribs. This wasn't supposed to happen. You have an IUD. It’s supposed to be the "set it and forget it" miracle of modern medicine, boasting a success rate that beats out almost every other form of birth control. Yet, here you are. Getting pregnant with an IUD is statistically rare, but for the people it happens to, the statistics don't really matter. You're not a decimal point; you're a person with a positive test and a whole lot of questions.
Honestly, it’s a total head-trip.
The IUD—whether it’s the copper ParaGard or a hormonal version like Mirena, Kyleena, Liletta, or Skyla—is more than 99% effective. According to the American College of Obstetricians and Gynecologists (ACOG), the failure rate is less than 1% per year. To put that in perspective, that’s more reliable than a vasectomy in some cases. But "less than 1%" isn't zero. When you’re that one person out of a hundred, the world feels a bit upside down.
How does this even happen?
Most of the time, the IUD is a fortress. It sits in the uterus and either uses copper to create a toxic environment for sperm or releases progestin to thicken cervical mucus and thin the uterine lining. It’s a double-layered defense. So how does a rogue sperm make it through?
The most common culprit is displacement. Your IUD has to be in the perfect spot—the fundus, or the very top of the uterus—to work its magic. Sometimes, your body just isn't having it. The uterus is a muscle, and it can occasionally cramp so hard that it pushes the device out of place. This is called "expulsion." If it slips down into the cervix or falls out entirely (which can happen during a heavy period without you even noticing), the protection drops to zero.
Another factor is timing. If you have a hormonal IUD inserted and don't use backup protection during those first seven days, you’re at risk. With the copper IUD, it's effective immediately, but even then, if it was placed incorrectly from the jump, you’re vulnerable.
Then there’s the rare stuff. Sometimes the IUD is exactly where it’s supposed to be, but the biology just... finds a way. No birth control is 100% effective because human bodies are incredibly resilient and occasionally unpredictable.
The Ectopic Risk: What You Must Know
We need to talk about the scary part immediately. If you are getting pregnant with an IUD, the risk of that pregnancy being ectopic is significantly higher.
An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in the fallopian tube. Because the IUD is so good at preventing implantation inside the uterus, any pregnancy that manages to take hold is statistically more likely to be elsewhere. This is a medical emergency. A fallopian tube isn't designed to stretch like a uterus; it can rupture, causing life-threatening internal bleeding.
If you have a positive test and feel sharp, one-sided pelvic pain, extreme dizziness, or shoulder pain (which is a weird sign of internal bleeding pressing on nerves), go to the ER. Don't wait for an appointment. Don't "see how it feels" in the morning.
Spotting the Signs Early
Sometimes the symptoms of an IUD pregnancy are masked by the side effects of the IUD itself. It's confusing. Many people on Mirena or Kyleena stop having periods entirely, so a "missed period" doesn't trigger the usual alarm bells. You might just feel a bit "off."
- Breast tenderness: This often feels different than typical PMS soreness. It’s more intense.
- Nausea: The classic "morning sickness," though it can hit at 3:00 PM or while you're trying to sleep.
- Fatigue: A bone-deep tiredness that a cup of coffee won't touch.
- Spotting: This is the tricky one. IUDs cause spotting anyway, but implantation bleeding is a specific, light pink or brown discharge that happens when the embryo attaches.
If you have an IUD and start feeling these things, take a test. They are cheap, available at every drugstore, and remarkably accurate. If it’s positive, your next call is your OB-GYN.
What the Doctor Will Actually Do
When you call your doctor and say "I have an IUD and a positive pregnancy test," you will usually be bumped to the front of the line. This is not a "we can see you in three weeks" situation.
First, they’ll confirm the pregnancy with a blood test to check your hCG levels. Then comes the ultrasound. The goal here is twofold: find where the pregnancy is located and find where the IUD is hiding.
If the pregnancy is viable and in the uterus, you have a big decision to make. But before that, the doctor will likely recommend removing the IUD. Research shows that leaving an IUD in place during pregnancy significantly increases the risk of miscarriage, preterm labor, and infection (chorioamnionitis). Removing it also carries a slight risk of miscarriage, but the risks of leaving it in are generally considered much higher.
It’s a delicate balance. If the strings are visible, the doctor can usually pull it out easily. If the strings have retracted into the uterus, it gets more complicated and might require using a small tool or ultrasound guidance to locate and remove it.
The Odds and the Outcomes
Let's look at some real numbers because they help ground the panic. A study published in Obstetrics & Gynecology noted that while the risk of complications is higher, many people do go on to have healthy pregnancies after an IUD failure, especially if the device is removed early in the first trimester.
However, the rate of spontaneous abortion (miscarriage) is approximately 40% to 50% if the IUD is left in place. If it's removed, that risk drops significantly, but stays higher than a "normal" pregnancy.
There's also the question of the baby's health. There is no evidence that IUDs cause birth defects. The copper or the hormones in the IUD work locally; they don't circulate through the bloodstream in a way that would "poison" a developing fetus. The primary risks are mechanical—related to the physical presence of the device and the risk of infection.
Navigating the Emotional Fallout
Getting pregnant when you’ve taken active, medical steps to not be pregnant is a unique kind of stress. You might feel betrayed by your own body or by the medical device you trusted. Some people feel a sense of "meant to be," while others feel pure, unadulterated panic.
Both are fine.
You have options. Whether you want to continue the pregnancy or terminate it, the presence of an IUD complicates the medical process but doesn't take away your choices. If you choose termination, the IUD will be removed during the procedure. If you choose to continue, you'll be categorized as a "high-risk" pregnancy, at least initially, meaning more frequent check-ups and ultrasounds to ensure everything is progressing safely.
Immediate Actionable Steps
If you are reading this because you just saw two lines on a stick, here is your checklist. No fluff, just what needs to happen.
- Call your OB-GYN or a local clinic immediately. State clearly that you have an IUD and a positive test.
- Do not try to remove the IUD yourself. This sounds obvious, but panic does weird things to people. You can cause severe trauma to your cervix or uterus.
- Monitor for pain. Any sharp, stabbing pain in your abdomen or pelvis needs an ER visit.
- Gather your data. When was your IUD inserted? What brand is it? When was your last "normal" period or spotting?
- Check your strings. If you can feel them, it’s a good sign the IUD hasn't migrated too far, but it doesn't mean you're in the clear.
The reality of getting pregnant with an IUD is that it is a medical anomaly that requires professional intervention. You aren't "bad" at birth control, and your body hasn't failed you—you’ve just ended up on the wrong side of a very small percentage. Take a breath. Call the doctor. One step at a time is the only way through.