Do IUDs Cause Infertility? What if I Can't Get Pregnant After Removal?

The Research on IUDs and Fertility & What to Do if You Can't Pregnant

images of several birth control options including the ring, birth control pills, and an IUD
IUDs are small T-shaped devices made of flexible plastic. Though older IUDs were suspected of causing infertility, modern IUDs are considered fertility safe. BSIP/UIG / Getty Images

Can an IUD make you infertile? This concern has kept many women from considering IUDs. The fear is that an IUD may increase your risk of pelvic infection. Pelvic infection can cause scar tissue and blocked fallopian tubes (or tubal infertility.)  

IUDs are a convenient and generally safe form of reversible birth control. Current research has not found an increased risk of infertility in women who use IUDs.

So what’s behind the IUD infertility concerns?

What Is an IUD?

First, it would help to understand what IUDs are.

IUD stands for intrauterine device. They are small, T-shaped devices made of flexible plastic. An IUD is placed inside the uterus via the cervix. Only a doctor can place and remove an IUD. This is an in-office procedure.

There are two basic types of IUDs: copper and hormonal.

Copper IUDs, like ParaGard, work without hormones – an important benefit for those who do not want or can’t use hormonal based birth control. Copper repeals the sperm, preventing pregnancy.

Once placed, a copper IUD can provide effective birth control for up to 10 years.

Hormonal IUDs include brands like Mirena and Sklya. They are good for up to five and three years, respectively. They release the hormone progestin. This thickens cervical mucus and suppresses ovulation.

The IUD rests inside the upper cavity of the uterus, while small plastic strings attached to the end of the IUD run through the cervix and into the vagina.

They do not hang out of your vagina like tampon strings but you can feel for them if you reach back to your cervix.

Whichever kind of IUD you use, it can be removed when you want to have a baby. You do not have to wait the full number of effective years. (In other words, just because the copper IUD can last for 12 years doesn’t mean you have to continue using it for the entire time period.)

Once removed, your fertility should return within one month’s time.

Learn more about IUDs from Dawn Stacey, About.com’s Contraception expert:

IUDs got their bad reputation from the combination of two issues: a poorly designed early IUD called the Dalkon Shield and lack of effective STD screening in the 1970s.

The Dalkon Shield: The Early IUD That Gave All IUDs a Bad Name

Popular in the early 1970s, The Dalkon Shield was a brand of IUD.

The design of the plastic tail strings increased the risk of pelvic infection. Bacteria could travel up the strings and into the uterus, increasing the risk of contracting a pelvic infection. (This is not true in current IUDs.)

In fact, the risk of contracting pelvic infection with the Dalkon Shield was seven times higher than in women who did not use IUDs and five times higher than in women using other IUDs of that time.

After an avalanche of lawsuits, the Dalkon Shield was removed from the market.

The publicity around this early IUD led to women and doctors shying away from IUD use.

Early IUD Research and the Lack of STD Testing

Another reason for fear surrounding IUDs was the lack of STD screening in the early 1970s.

Chlamydia is a sexually transmitted disease (STD) that can lead to pelvic inflammatory disease (PID) and infertility.

When IUDs were new, there did not exist a test for chlamydia. If a woman didn’t have symptoms (and in the early stages, they usually don’t), the doctor could not know she was infected.

This means, however, that women who were already at risk for pelvic infection were given IUDs. This is a problem for two reasons.

One, if the woman later is diagnosed with infertility, it’s not possible to know whether it was due to the IUD or the sexually transmitted disease she already had.

And, second, if a woman already has an STD, placing an IUD increased the risk of her developing PID. The IUD irritates an already infected uterus. (Today, doctors test for STDs before prescribing an IUD for this reason.)

Early studies on IUD use and infertility risk were not able to distinguish between women who had contracted the STD before or after the IUD was placed.  

This means it was impossible to know whether...

  • the IUD led to infection and infertility,
  • the IUD increased the woman’s risk of getting an STD, which then in turn caused infertility,
  • or if an STD was a problem from before the IUD was placed

These early (but flawed) studies led the FDA to require warnings on all IUD packaging. The warning label advised doctors not to place IUDs in women who had not yet had children.

The Current Research on IUDs and Fertility

Times have changed.

The modern IUD designs are not associated with an increased risk of pelvic infection (except for a small increased risk within the first month of placement – more on this below.)

Also, better screening of STDs means women can be diagnosed and treated for potential pelvic infectious diseases before IUD placement.

Research based on approximately 22,000 IUD insertions and approximately 51,000 “woman-years” (i.e., the total number of years all 22,000 women used an IUD), the overall risk of contracting PID during IUD use was 1.6 cases per 1,000 woman-years of use.

This is similar to the risk a woman has who has never used an IUD.

However, the risk of pelvic infection is higher during the first 20 days after insertion.

Researchers found that the odds of contracting PID during the first 20 days is six-times higher (9.66 women per 1,000 women-years). That's a fraction less than 1 in 100.

The good news is that the risk is still relatively low overall, and the risk period is short.

Once the 20 days pass, the risk drops down to 1.6. It continues to be this low as long as the IUD is in place.

It’s important that you report to your doctor any worrisome symptoms you have after placement, so if you do get an infection, it can be treated right away.

What If You Can’t Get Pregnant After an IUD?

After IUD removal, your fertility should return within one month.

If you don’t conceive after six months of unprotected sex (or after 12 months, if you’re younger than 35), you should see a doctor.

It’s natural to worry your IUD may have caused your fertility problems. While you should make sure your doctor knows you had an IUD, the odds of the IUD directly causing infertility are low.

In a study of 1,895 women, researchers looked at women who were diagnosed with infertility due to blocked fallopian tubes, women with infertility due to another cause, and pregnant women (who did not experience infertility.)

The researchers looked at what birth control methods they used in the past, whether or not they ever had an IUD, their sexual relationship history, and their history of genital infections. They also tested all the women for chlamydia.

They found that previous IUD use was not associated with a higher risk of having blocked fallopian tubes. They did, however, find that infection with chlamydia increased their risk.

There are many possible causes of female and male infertility. Pelvic inflammatory disease and blocked fallopian tubes are only two possible causes.  

If you’re struggling to conceive – no matter what kind of birth control you have used or not in the past – see your doctor. Don’t wait.

What If Your Doctor Won’t Prescribe an IUD?

Some women want an IUD but have trouble finding a doctor who will prescribe one. 

Despite the current medical evidence, some doctors are still hesitant to prescribe an IUD for a woman who has never been pregnant or given birth. These doctors are going on old information.

In 2005, due to the current research on fertility and IUDs, the FDA allowed the removal of warnings from copper IUDs. They no longer state that women who have not given birth shouldn’t use the device.

The Skyla IUDs never had such a warning because clinical trials included women who had not given birth.

The position of the American College of Obstetricians and Gynecologists (ACOG) is that IUDs are not only safe for women who have not yet given birth, but that they are a preferred method of reversible birth control for teens.

The Society of Family Planning also recommends IUDs for women who have and haven’t yet given birth.

If your doctor refuses to prescribe an IUD, and you’d like one, ask your doctor why they don’t recommend this form of birth control for you. Your doctor may have some legitimate concerns that pertain to your particular medical situation.

For example, if you practice high-risk sexual behaviors and are at higher risk of contracting a sexually transmitted disease, an IUD may not be the best choice for you.

Remember that you can always get a second opinion.

Sources:

Beerthuizen RJ1. “Pelvic inflammatory disease in intrauterine device users.” Eur J Contracept Reprod Health Care. 1996 Sep;1(3):237-43. http://www.ncbi.nlm.nih.gov/pubmed/9678122

Carpentier, Megan. “Why Women Don't Get IUDs.” Jezebel.com. Accessed August 24, 2015. http://jezebel.com/5325783/why-women-dont-get-iuds

Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. “Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.” Obstet Gynecol. 2012 Oct;120(4):983-8. http://www.ncbi.nlm.nih.gov/pubmed?term=22996129

Dean, Gillian MD, MPH;  Goldberg, Alisa B MD, MPH. Intrauterine contraception (IUD): Overview. UpToDate.com. Accessed August 24, 2015. http://www.uptodate.com/contents/intrauterine-contraception-iud-overview

Hubacher D1, Lara-Ricalde R, Taylor DJ, Guerra-Infante F, Guzmán-Rodríguez R. “Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.” N Engl J Med. 2001 Aug 23;345(8):561-7. http://www.ncbi.nlm.nih.gov/pubmed?term=11529209

Hubacher D1, Grimes DA, Gemzell-Danielsson K. “Pitfalls of research linking the intrauterine device to pelvic inflammatory disease.” Obstet Gynecol. 2013 May;121(5):1091-8. doi: 10.1097/AOG.0b013e31828ac03a. http://www.ncbi.nlm.nih.gov/pubmed?term=23635748

IUDs and Contraceptive Implants Safe for Teens. ACOG News Release. Published: September 20, 2012. Accessed August 24, 2015. http://www.acog.org/About-ACOG/News-Room/News-Releases/2012/IUDs-and-Contraceptive-Implants-Safe-for-Teens

Kolata, Gina. “The Sad Legacy of the Dalkon Shield.” New York Times. Published: December 6, 1987 http://www.nytimes.com/1987/12/06/magazine/the-sad-legacy-of-the-dalkon-shie.html

Lyus R, Lohr P, Prager S; Board of the Society of Family Planning. “Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women.” Contraception. 2010 May;81(5):367-71. doi: 10.1016/j.contraception.2010.01.010. Epub 2010 Feb 19. http://www.ncbi.nlm.nih.gov/pubmed?term=20399942

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