26) “Can You Get Pregnant While Using an IUD? (IUD Failure) What Happens Then? (Viewer Question)

hi i'm dr. christina der vadas welcome back to my channel talking I you see with dr. D in today's video we are going to continue with my series of videos dedicated to viewer questions and questions specifically that have been posed by someone who's been watching the key channel and has a specific question so viewer Rebecca has requested that I do a video speaking about what happens if someone gets pregnant with an IUD in place so addressing the question first of all is this possible can someone get pregnant well they are using an IUD while there is an IUD in place and so put another way what is the failure rate of the IUD and what is the chance of unplanned pregnancy and then second to that I'm going to talk about what happens what do we do if that happens and in that situation where there's been a pregnancy with an IUD in place so to answer the first part of the question unfortunately yes it is possible to get pregnant with an IUD in place the IUD is very very effective at preventing pregnancy in fact the most effective reversible contraceptive option that we have available to us in Canada with a 2 per thousand chance of pregnancy with the levonorgestrel iud so that would be Mirena or kaileena and an eight a six to eight per thousand chance of pregnancy with the copper IUD so the bottom line is the chance of pregnancy is very very low much lower compared to other contraceptive options but it is unfortunately not zero really the only method of contraception that guarantees a zero chance of pregnancy is abstinence which is an option for some couples or some patients but in other circumstances where you're relying on contraception to prevent pregnancy there is no method is 100% perfect so keeping this in mind and to put things into perspective so we're 2 to 8 per thousand women using an IUD might get pregnant so less than 1% the real-world efficacy of the birth control pill actually has a failure rate of about 9% when we're talking about condoms for example the chance of pregnancy is 18% now in the media when there's stories of a patient getting pregnant with an IUD in place it's seen as a very big deal because I think there's a misconception out there that the IUD is supposed to be perfect which it is not I've seen media stories where you know the headline women gets pregnant with an IUD in place and then they ultimately show the subsequent baby after having gone through a term pregnancy the baby is there holding the IUD in its hand and you know it's all very sensational so in that situation what I have always said to patients is that you know for that one baby holding the IUD that failed to be fair the same newspaper article should also show a lineup of 18 babies holding up packages of birth control pills that fate failed or comparably 36 babies lined up holding up condoms that failed so when you look at the comparative numbers looking at the IUD versus other options of contraception yes unfortunately there is a small chance of pregnancy but the chance is much much lower compared to those other methods that I've just mentioned so in terms of what are our concerns or what happens if a patient gets pregnant with an IUD in place one of the things that we need to rule out or investigate is to check whether the pregnancy is inside the uterus or whether it is inside the fallopian tubes which is called a tubal pregnancy now relatively speaking if someone is one of the very rare less than 1% who gets pregnant with an IUD in place there may be more of a chance that the pregnancy is in the fallopian tube or what we call a tubal pregnancy or an ectopic pregnancy however when you compare big picture looking at women who are on all contraceptive other options or no contraception the overall rate of tubal pregnancy is still lower with IUD use simply because the overall pregnancy rate in general is so much lower however if someone is one of those rare patients who does conceive well an IUD is in place we definitely need to do further investigations to check whether or not the pregnancy is in the uterus or in the fallopian tube and so that usually involves both bloodwork confirming the pregnancy and to give us an idea of how far along the pregnancy is and then ultrasound to show the exact location of the pregnancy now if there is concern for a tubal pregnancy this is a very serious situation that needs to be followed closely it could turn into a medical emergency if it were to proceed without being appropriately followed so the concern with a tubal pregnancy is that the tube could actually burst or rupture and that could cause significant bleeding into the abdominal cavity and could be a surgical emergency or an emergency situation where someone is losing a lot of blood because of the easy access to pregnancy testing blood work early ultrasound seeing that sort of an extreme situation has become more and more rare in modern day gynecology however to re-emphasize a tubal pregnancy or if there's any concern that there might be a tubal pregnancy we have to treat that education very very seriously some tubal pregnancies may resolve spontaneously that's less common but still a possibility some tubal pregnancies we treat with a medication called methotrexate and in other tubal pregnancies we may need to actually proceed to the operating room to do a surgery to remove the pregnancy oftentimes that can be done in a minimally invasive fashion with just very small incisions and little video cameras I'm not going to get into the full details about ectopic pregnancy per se but that just very briefly is sort of an overview of what might happen if we were worried that there might be a tubal pregnancy with someone who's gotten pregnant with an IUD in place what are the signs to look out for if you think that you might be pregnant with an IUD in place in terms of just speaking of ectopic pregnancy things that we might look out for would be pain on one side of the or the other of the lower abdomen if we were worried that things had progressed to the point of progressed to the point of where there was risk of a tubal rupture or bleeding we'd look out for any signs of dizziness lightheadedness pain in the right shoulder tip or either shoulder tip which can be due to what we call referred pain bleeding can be a sign as well in terms of just looking at symptoms of pregnancy in general if we're worried about an intrauterine pregnancy some of the symptoms could be nausea breast tenderness irregular bleeding unfortunately many of these symptoms are also potential symptoms that can happen as part of the adjustment phase of an IUD having been inserted or maybe although rarely but maybe side-effects with regards to IUD use the bottom line is if someone is worried the they might be pregnant then definitely we need to follow up with usually starting with a urine pregnancy test or even more accurately a blood pregnancy test now many women with for example the Mirena IUD or the kaileena IUD may not have a menstrual cycle at some point in time because the progesterone has thinned out the lining of the uterus and so they're not having a cycle and so in those patients I often have the question well then how am I supposed to know if I have a pregnancy with the IUD in place because my periods are gone so I wouldn't have that warning of the missed cycle so for my patients I'd say the first time that that happens where you don't have a cycle because your cycles have been getting lighter and lighter and you're not cycling on the levonorgestrel iud you can raise your yourself by doing a home pregnancy test just to be certain but thereafter if you continue to not men straight and or having almost non-existent cycles it's not actually necessary to continue to do a pregnancy test each month now in terms of what are the options if someone has has a pregnancy that's intrauterine while an IUD is in place first of all just to reiterate if it is a tubal pregnancy there is no possibility of the pregnancy safely continuing and it needs to be managed as such if someone finds that they have become pregnant with an IUD in place and it's intrauterine than we do have some options first of all in all situations regardless of how the patient decides to proceed we do attempt to remove the IUD immediately and sometimes this is possible in other situations the IUD may have migrated further up into the uterus and the strings aren't visible and we're not able to remove the IUD but if we are able to do so easily that may remove the IUD and if the patient chooses to terminate the pregnancy then obviously she would be referred to a clinic or a center where that procedure is performed in the event that the IUD hadn't been removed previously it can be removed at the time of the termination I would also note that having had one eye ud failure does not necessarily mean that you can't use an IUD again or that if you do use an IUD again that you're going to have another IUD failure and so in a patient who has a termination removal of the in place IUD it is theoretically possible to reinsert a new IUD at the time of that procedure often times in those situations we will have done additional ultrasound imaging to rule out any particular reason that may have caused the IUD failure we want to make sure that there's not some sort of uterine abnormality that may have caused the failure but as long as there's not any sort of structural cause that may have led to the IUD failure than it is possible to reinsert a new IUD at the time of termination for those patients that decide to continue on with the pregnancy it is considered a higher risk pregnancy because of the potential risks associated with having the IUD in place those risks include the risk of miscarriage the risk of preterm delivery there's a risk of preterm premature rupture of membranes some studies have shown an increased risk of low birth weight infants having said all that I have in my practice seen several patients who have gone on to have healthy term uncomplicated deliveries despite an IUD being in place and then usually what happens if the IUD hadn't previously been removed it's removed at the time of delivery usually found within the membranes or close to the placenta but we would just remove it at that time so obviously if this situation happens your obstetrician-gynecologist would be going through all of these potential increased risks with you and coming up with a plan for surveillance and watching the pregnancy a bit more closely now just to go back a step and address some of the potential reasons why might an IUD fail again it's very rare but some of the potential reasons that an IUD might fail could be IUD male positioning so if there had been an expulsion or a partial expulsion of the IUD and I did do a separate video on I you D expulsion I think that's video 24 but if there is an expulsion or a partial expulsion of the IUD and the patient isn't isn't aware that that's happened and has continued on without using back-up contraception then certainly an out of position IUD might predispose to pregnancy another situation might be if a patient has had a hormonal IUD inserted and then immediately is sexually active without backup contraception that could potentially lead to a pregnancy well a copper IUD is usually effective fairly immediately a hormonal IUDs AF Ekta v' depending on when in the menstrual cycle its inserted and so definitely as a precaution I advise patients that they should use backup contraception for at least the first week after a hormonal IUD insertion and as an extra precaution I usually say to use backup contraception right up until the follow-up visit with me usually a month later because I thought visit I also have a chance to check the IUD and make sure that there's not been any sort of expulsion another situation where someone might get pregnant with an IUD in place is if they have left the IUD in for too long and it's actual utility has expired so for example for a five-year copper IUD if the page has left it in past the five year mark and it's not using further backup contraception or similarly for a five year hormonal IUD if it's been in for too long without being replaced and the patient is continuing to be sexually active without any other form of contraception then obviously that might predispose to pregnancy another unique situation where we might find a patient ending up pregnant with an IUD in place is if the IUD is actually inserted while the patient is pregnant or just pregnant so in my practice I go to fairly extreme lengths to try to guarantee that this doesn't happen and that's why where there's any doubt in my mind based on the clinical history or the patient's menstrual history if there's any doubt as to whether or not that patient might be pregnant on the day of the IUD insertion then I actually have the patient do a blood pregnancy test so I can be certain that I'm not inserting the IUD into a pregnant or just pregnant uterus because then obviously it would be a setup potentially for a more complicated pregnancy if she did end up ultimately being pregnant with an IUD in place so so those are some of the potential explanations as to why you might have a failure of the IUD as I mentioned previously if you have experienced an IUD failure it does not necessarily preclude future are you D use it does not necessarily mean that you would potentially have a failure of the IUD in the future but I in my practice usually for those patients will do some extra imaging or specialized I you are a specialized ultrasound rather to rule out any sort of uterine anomalies or abnormalities that may have predisposed to the IUD not functioning or mount positioning of the IUD so I would want to any of those problems before we perceived with another IUD in the future so those are the main points that I wanted to cover here it's sort of a more complex topic so this was a bit of a longer video I do apologize but I hope that I've answered most of the questions out there and certainly if there are any residual questions on this topic please feel free to get in touch with me through the comments section thank you once again to Rebecca for suggesting this video topic I will end today's video as I do always by reminding you that in less than the time that it took for you to watch this video you could have had an IUD inserted the process takes about five minutes and provides up to five years of worry free contraception thanks for watching and we'll see in the next video take care

Channel: Dr. Kristina Dervaitis

Views: 100,139

Keywords: IUD, IUC, Mirena, Kyleena, Copper IUD, Levonorgestrel IUD, Failure, IUD Failure, pregnant with IUD, tubal pregnancy with IUD, intrauterine pregnancy with IUD, contraception, gynecologist

Id: BYIS7FDZFZQ

Length: 18min 24sec (1104 seconds)

Published: Mon Aug 12 2019