You’re staring at two pink lines. Your heart is basically doing a drum solo in your chest. You have an IUD—a Mirena, a Paragard, maybe a Kyleena—and it was supposed to be 99% effective. You’re the 1%.
It feels impossible. Honestly, it’s a total "glitch in the matrix" moment. But here you are. Getting pregnant with an IUD is rare, but it’s a reality for about 1 in 100 people over a five-year period. While it’s scary, panicking doesn't help. We need to talk about the mechanics of how this happens, the risks you actually face, and why your next thirty minutes should involve a phone call to a clinic, not a deep dive into terrifying Reddit threads.
The Reality of IUD Failure: How Did This Even Happen?
IUDs are "set it and forget it." That’s the draw. But they aren't magic shields; they’re medical devices.
Most of the time, when someone gets pregnant with an IUD, it’s because the device moved. This is called displacement or expulsion. Your uterus is a muscle. Sometimes, particularly in the first few months after insertion, it tries to kick the IUD out. If the device slips even a few centimeters down into the cervix, that "99% effectiveness" drops faster than a lead weight. You might not even feel it happen.
There’s also the rare case where the IUD is perfectly placed, but a rogue egg and a very determined sperm meet anyway. No birth control—short of abstinence or surgery—is 100% foolproof.
Why the type of IUD matters right now
The hormonal IUD (like Mirena or Liletta) works by thickening cervical mucus and thinning the uterine lining. The copper IUD (Paragard) creates an inflammatory environment that’s toxic to sperm. If you’re pregnant, the mechanism failed. Period.
The Ectopic Risk: The Conversation You Have to Have
We have to be blunt here. If you’re pregnant with an IUD, the biggest immediate concern is an ectopic pregnancy.
In a normal pregnancy, the egg nests in the uterus. In an ectopic pregnancy, it sets up shop somewhere else, usually a fallopian tube. Because an IUD is so good at preventing uterine implantation, if a pregnancy does occur, there’s a much higher statistical chance it’s located outside the womb.
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According to data from the American College of Obstetricians and Gynecologists (ACOG), while the overall risk of pregnancy is low, about half of those who do get pregnant with an IUD will have an ectopic pregnancy. This is a medical emergency. If the tube ruptures, it causes internal bleeding.
Watch for these signs right now:
- Sharp, stabbing pain on one side of the pelvis.
- Shoulder pain (this is a weird sign of internal bleeding pressing on nerves).
- Fainting or extreme dizziness.
- Vaginal spotting that looks different from a period.
If you have these, stop reading and go to the ER. Seriously.
Should the IUD Stay or Go?
If the pregnancy is intrauterine (meaning it’s in the right place), you’re faced with a choice and a medical hurdle.
Most doctors will strongly recommend removing the IUD as soon as possible. Why? Because leaving it in increases the risk of a septic miscarriage. That’s an infection that can become life-threatening. There’s also a significantly higher risk of preterm labor and Chorioamnionitis (an infection of the membranes surrounding the baby).
The catch? Taking it out also carries a risk.
Pulling the strings to remove the device can sometimes trigger a miscarriage. It’s a "damned if you do, damned if you don't" scenario. However, the medical consensus—backed by decades of stats—is that the risks of leaving it in far outweigh the risks of a controlled removal by a professional.
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What if the strings are missing?
Sometimes the strings "up and vanish." They might have retracted into the cervical canal. If the doctor can’t see them, they might use ultrasound guidance to find the device. In some cases, if the IUD is positioned in a way that removing it would definitely terminate the pregnancy, and the person wants to carry to term, the doctor might leave it. But that is a high-risk pregnancy path that requires a specialist.
Navigating the Emotional Whiplash
Let’s be real. You weren’t planning this.
You got an IUD specifically to avoid this. There is a specific kind of anger that comes with a "fail-safe" failing. You might feel betrayed by your own body or by the medical system. That’s normal.
You have three paths:
- Continuing the pregnancy: This will involve an early ultrasound to check placement and likely the removal of the IUD. You’ll be monitored more closely for the first trimester.
- Termination: Many people choose an IUD because they are certain they don’t want children or aren't ready. If you choose to terminate, the IUD is typically removed during the procedure.
- Adoption: A path that involves the same medical risks as continuing the pregnancy but a different long-term outcome.
There is no "wrong" feeling here. Just the one you're having.
Statistics That Ground the Panic
It’s easy to feel like an anomaly. But look at the numbers. The failure rate for the copper IUD is about 0.8%, and for the levonorgestrel (hormonal) IUD, it’s about 0.1% to 0.4% in the first year.
Over time, that cumulative risk grows slightly.
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A 2015 study published in Obstetrics & Gynecology followed thousands of women and confirmed that while IUDs are among the most effective forms of reversible contraception, the small number of failures that do occur often involve improper placement.
If you just had your IUD put in two weeks ago and you’re pregnant? It likely wasn’t seated correctly. If you’ve had it for six years? It might have shifted, or the hormone levels might be tapering (though most are now approved for 5–10 years).
What Your Doctor Visit Will Actually Look Like
When you call and say "I have an IUD and a positive test," they will likely move you to the front of the line. This isn't a "wait two weeks" situation.
First, they’ll do a blood test (quantitative hCG). This measures the exact level of pregnancy hormones.
Next comes the transvaginal ultrasound. This is the big one. They need to see where that embryo is. If they see the IUD sitting right next to a gestational sac in the uterus, they’ll discuss the removal process. If the uterus is empty but your hormone levels are high, they start looking at the tubes.
Managing the Risk of Infection
If you decide to continue the pregnancy and the IUD is removed, you aren't totally out of the woods, but the risk drops.
If the IUD cannot be removed, you have to be hyper-vigilant. Any fever, any weird discharge, any cramping that feels "off"—you call the OB-GYN. Septicemia isn't something to mess with. It’s rare, but when it happens, it moves fast.
Actionable Next Steps: Your 24-Hour Plan
Don't just sit on this information.
- Confirm with a second test. Use a different brand if it makes you feel better, but if that second line is there, believe it.
- Call your OB-GYN or a local clinic immediately. Mention the IUD first. It changes the urgency of the appointment.
- Locate your IUD card. If you still have the card from when it was inserted, find it. It tells the doctor exactly what model you have and when it was put in.
- Check your strings (carefully). Wash your hands and see if you can feel them. If they feel longer than usual, or if you feel the hard plastic of the IUD itself, tell the doctor. This confirms displacement.
- Monitor for pain. Any severe abdominal pain is a reason to go to the emergency room tonight.
Getting pregnant with an IUD is a massive curveball. It’s a medical complication, a logistical headache, and an emotional rollercoaster all at once. But millions of people have navigated this. The technology is great, but biology is persistent. Focus on the medical facts, get the ultrasound, and take it one hour at a time.