It’s the gold standard for many people who want "set it and forget it" birth control without the hormones. You get the copper T-shaped device inserted, and the stats say you’re basically safe for a decade. But then, the period doesn’t show. Or the spotting feels... different. If you’re staring at a positive test while pregnant on the Paragard IUD, your brain is probably racing through a million "how" and "why" questions.
It’s rare. We’re talking less than 1% rare. But "less than 1%" isn't 0%. When you are that one person in a hundred, the statistics don't really matter anymore. You just need to know what this means for your health, your pregnancy, and that little piece of copper currently sitting in your uterus.
Honestly, the shock is the hardest part. You chose this specifically so you wouldn't have to think about pregnancy. It feels like a betrayal by your own body or the medical device you trusted.
How Does Someone Get Pregnant on the Paragard IUD?
The Paragard is a non-hormonal intrauterine device. It works by releasing copper ions that create an inflammatory response. Basically, it makes the uterus a very hostile environment for sperm. It’s like a tiny, toxic (to sperm) shield.
So, how does it fail?
Most of the time, the IUD has moved. This is called malposition or expulsion. Your uterus is a muscle, and sometimes it just... pushes back. If the Paragard slips down into the cervix or falls out entirely (which can happen without you even noticing during a heavy period), its effectiveness drops to nearly zero. According to a study published in Contraception, about 2% to 10% of IUDs are expelled within the first year. If it’s not in the "fundus"—the very top of the uterus—it can’t do its job properly.
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There's also the rare "perfectly placed failure." This is when the IUD is exactly where it should be, but a super-sperm somehow makes it past the copper gauntlet and finds an egg. It’s incredibly uncommon, but biology is persistent.
The Immediate Risks You Need to Know
If you suspect you’re pregnant or have a positive test, this isn't a "wait and see" situation. You need a doctor. Like, today.
The biggest concern is an ectopic pregnancy. This is when the embryo implants outside the uterus, usually in the fallopian tube. Because the Paragard is so good at preventing uterine implantation, if a pregnancy does happen, there’s a much higher statistical chance that it's ectopic compared to the general population. Ectopic pregnancies are life-threatening because the tube can rupture.
- Sharp, stabbing pains in the pelvis or abdomen
- Vaginal bleeding that feels different from a period
- Shoulder pain (a weird but real sign of internal bleeding)
- Dizziness or fainting
Even if it’s not ectopic, an intrauterine pregnancy with an IUD still in place carries its own baggage. There is a significantly higher risk of miscarriage, preterm labor, and infection (chorioamnionitis) if the device stays in.
Removing the IUD: The Big Decision
When you see your OB-GYN, the first thing they’ll likely do is an ultrasound. They need to see where the pregnancy is and where the Paragard is.
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If you plan to continue the pregnancy, doctors almost always recommend removing the IUD immediately. Research from the American College of Obstetricians and Gynecologists (ACOG) shows that leaving the IUD in place during pregnancy increases the risk of early pregnancy loss by about 50%. Removing it also carries a small risk of miscarriage, but that risk is generally considered lower than the risk of leaving it in.
If the strings are visible, the doctor can usually just pull it out gently. If the strings have retracted into the uterus, things get trickier. They might need to use ultrasound guidance to retrieve it.
Realities of the "Copper IUD Baby"
There is a weird urban legend that babies born with a Paragard are born "holding the IUD." Let’s clear that up: that doesn't happen. Photos you see online are usually staged or the IUD was found in the placenta after birth. The IUD stays outside the amniotic sac. It doesn't fuse with the baby.
However, the copper itself isn't known to cause birth defects. The Paragard works locally; it doesn't flood your bloodstream with chemicals that mess with fetal development. The primary risks are mechanical—the physical presence of the device causing irritation, infection, or premature rupture of membranes.
Navigating the Emotional Fallout
Getting pregnant on the Paragard IUD is a unique kind of stress. You might feel angry at the manufacturer, your doctor, or your own body. You might be facing a choice you never thought you’d have to make again.
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It’s okay to feel conflicted. It’s okay to be mad that your "99% effective" birth control landed you in the 1%.
Take a breath. Talk to a provider who listens to you. If you feel like your concerns are being dismissed with a "well, this is rare," find a different doctor. You deserve a clear medical plan, not a lecture on statistics.
Actionable Steps for Moving Forward
If you have a positive test and a Paragard, follow this roadmap:
- Call your clinic immediately. Tell the receptionist, "I have a Paragard IUD and a positive pregnancy test." This usually gets you an urgent appointment because of the ectopic risk.
- Monitor for pain. If you have severe one-sided cramping or feel lightheaded, go to the Emergency Room. Do not wait for your scheduled appointment.
- Confirm the location. Ensure your doctor performs a transvaginal ultrasound to rule out an ectopic pregnancy.
- Discuss IUD removal. If the pregnancy is in the uterus, ask about the risks of removal versus the risks of keeping it in based on your specific IUD placement.
- Check your strings (for the future). For anyone else reading this who isn't pregnant yet, get in the habit of checking your IUD strings once a month after your period. If they feel longer, shorter, or gone, call your doctor. Most Paragard failures happen because the device moved and the person didn't know.
- Report the failure. You or your doctor can report the failure to the FDA’s MedWatch program. This helps track the real-world efficacy of medical devices.
Ultimately, you have to prioritize your physical safety first. Once the location of the pregnancy is confirmed and the IUD is addressed, you can take the time to figure out what the rest of your path looks like.