Getting pregnant despite having an intrauterine device (IUD) is very rare, but it can happen. A study conducted at Soroka University Medical Center and Ben-Gurion University of the Negev in Beersheba has found an increase in pregnancy complications and especially premature births in women who have an IUD when they got pregnant, but fortunately, there was no increase in neurological problems in the babies who were born, even until they reached the age of 18.
Prof. Eyal Sheiner, the lead researcher and head of the gynecology and obstetrics department at Soroka, which is owned and run by the Clalit Health Services health fund, said: “Since most pregnancies that occur despite an IUD should be without any complications to the baby, an informed decision about pregnancy management should be made.”
An intrauterine device is one of the most common reversible contraceptives in the world and is used by 23% of women who use contraception. The device is located in the uterine cavity, and in response to this presence, the uterus secretes substances that interfere with the movement of semen and its passage into the uterus, thus almost always preventing fertilization.
It is one of the most effective and popular forms of birth control, with a 99.7% efficiency rate. It is also a reversible contraceptive; it can be removed and stopped at any time, without impairing fertility. An intrauterine device is considered a convenient contraceptive and its use in terms of contraception are comparable to the safety of irreversible contraception, such as tying the fallopian tubes.
The IUD’s benefits also include its suitability for women between births, women who (are foolish enough to) smoke or those who cannot take contraceptive pills for medical reasons such as excessive blood clotting. In recent years, there has been a tendency to offer this effective measure to unmarried girls as well.
Pregnancy with an IUD in place typically has the same symptoms as any regular pregnancy – including breast tenderness, nausea and fatigue. It’s important to identify such a pregnancy early. An at-home pregnancy test might not indicate pregnancy as early as a blood test in the office would, so a woman who has an IUD and thinks she is pregnant should best be tested by a medical professional.
The most recent study in the journal Contraception examined the results of pregnancies among those women who became pregnant despite the presence of an intrauterine device and examined whether there was a difference between women who had the device removed after the pregnancy was proven or if it was left in the uterus throughout the pregnancy. The study also examined the long-term neurodevelopmental morbidity of children during a follow-up period until they turned 18.
The study found that during pregnancy under the standard there is an increase in pregnancy complications, including separation of the placenta, intrauterine infection and especially an increase in premature birth rates. Complications were seen in both groups, both in women who had the device removed when the pregnancy became known and in those whose device remained in the uterine cavity throughout pregnancy. In contrast to the short-term birth outcomes and despite an increase in the premature-birth rate, no increase in the neurodevelopmental complications of the children was observed, even with long-term follow-up until they became adults.
Sheiner concluded that while there was an increase in the rate of pregnancy complications among women who got pregnant with an IUD, it should be remembered that most pregnancies will be without any complications, and in fact the average gestational age of those women was 38 weeks (out of the normal 40), so an informed decision should be made about pregnancy management. The study did not show any benefit in terms of leaving in or removing the IUD, so each doctor and patient should decide individually what to do.