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

by Dr. Kristina Dervaitis · 2,659 words · 391 segments · language en · Watch on YouTube

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0:00hi i'm dr. christina der vadas welcome
0:04back to my channel talking I you see
0:06with dr. D in today's video we are going
0:09to continue with my series of videos
0:13dedicated to viewer questions and
0:16questions specifically that have been
0:18posed by someone who's been watching the
0:21key channel and has a specific question
0:23so viewer Rebecca has requested that I
0:27do a video speaking about what happens
0:31if someone gets pregnant with an IUD in
0:34place so addressing the question first
0:36of all is this possible
0:37can someone get pregnant well they are
0:41using an IUD while there is an IUD in
0:44place and so put another way what is the
0:47failure rate of the IUD and what is the
0:51chance of unplanned pregnancy and then
0:53second to that I'm going to talk about
0:55what happens what do we do if that
0:59happens and in that situation where
1:01there's been a pregnancy with an IUD in
1:03place so to answer the first part of the
1:07question unfortunately yes it is
1:09possible to get pregnant with an IUD in
1:12place the IUD is very very effective at
1:16preventing pregnancy in fact the most
1:18effective reversible contraceptive
1:21option that we have available to us in
1:22Canada with a 2 per thousand chance of
1:26pregnancy with the levonorgestrel iud so
1:29that would be Mirena or kaileena and an
1:32eight a six to eight per thousand chance
1:35of pregnancy with the copper IUD so the
1:38bottom line is the chance of pregnancy
1:40is very very low much lower compared to
1:43other contraceptive options but it is
1:46unfortunately not zero really the only
1:49method of contraception that guarantees
1:52a zero chance of pregnancy is abstinence
1:56which is an option for some couples or
1:59some patients but in other circumstances
2:02where you're relying on contraception to
2:05prevent pregnancy there is no method
2:08is 100% perfect so keeping this in mind
2:12and to put things into perspective so
2:15we're 2 to 8 per thousand women using an
2:20IUD might get pregnant so less than 1%
2:24the real-world efficacy of the birth
2:27control pill actually has a failure rate
2:31of about 9% when we're talking about
2:35condoms for example the chance of
2:37pregnancy is 18% now in the media when
2:43there's stories of a patient getting
2:45pregnant with an IUD in place it's seen
2:47as a very big deal because I think
2:49there's a misconception out there that
2:51the IUD is supposed to be perfect which
2:53it is not I've seen media stories where
2:56you know the headline women gets
2:59pregnant with an IUD in place and then
3:01they ultimately show the subsequent baby
3:06after having gone through a term
3:08pregnancy the baby is there holding the
3:10IUD in its hand and you know it's all
3:15very sensational so in that situation
3:19what I have always said to patients is
3:22that you know for that one baby holding
3:25the IUD that failed to be fair the same
3:30newspaper article should also show a
3:32lineup of 18 babies holding up packages
3:37of birth control pills that fate failed
3:39or comparably 36 babies lined up holding
3:45up condoms that failed so when you look
3:48at the comparative numbers looking at
3:51the IUD versus other options of
3:52contraception yes unfortunately there is
3:56a small chance of pregnancy but the
3:58chance is much much lower compared to
4:01those other methods that I've just
4:02mentioned so in terms of what are our
4:08concerns or what happens if a patient
4:10gets pregnant with an IUD in place one
4:15of the things that we need to rule out
4:17or investigate is
4:19to check whether the pregnancy is inside
4:22the uterus or whether it is inside the
4:25fallopian tubes which is called a tubal
4:28pregnancy now relatively speaking if
4:33someone is one of the very rare
4:36less than 1% who gets pregnant with an
4:39IUD in place there may be more of a
4:42chance that the pregnancy is in the
4:44fallopian tube or what we call a tubal
4:47pregnancy or an ectopic pregnancy
4:49however when you compare big picture
4:52looking at women who are on all
4:54contraceptive other options or no
4:57contraception the overall rate of tubal
5:00pregnancy is still lower with IUD use
5:04simply because the overall pregnancy
5:07rate in general is so much lower however
5:11if someone is one of those rare patients
5:13who does conceive well an IUD is in
5:16place we definitely need to do further
5:18investigations to check whether or not
5:20the pregnancy is in the uterus or in the
5:22fallopian tube and so that usually
5:25involves both bloodwork confirming the
5:27pregnancy and to give us an idea of how
5:30far along the pregnancy is and then
5:32ultrasound to show the exact location of
5:36the pregnancy now if there is concern
5:40for a tubal pregnancy this is a very
5:42serious situation that needs to be
5:44followed closely it could turn into a
5:47medical emergency if it were to proceed
5:50without being appropriately followed so
5:53the concern with a tubal pregnancy is
5:55that the tube could actually burst or
5:57rupture and that could cause significant
6:00bleeding into the abdominal cavity and
6:03could be a surgical emergency or an
6:05emergency situation where someone is
6:07losing a lot of blood because of the
6:10easy access to pregnancy testing blood
6:14work early ultrasound seeing that sort
6:17of an extreme situation has become more
6:20and more rare in modern day gynecology
6:23however to re-emphasize a tubal
6:27pregnancy or if there's any concern that
6:29there might be a tubal pregnancy we have
6:30to treat that
6:31education very very seriously some tubal
6:34pregnancies may resolve spontaneously
6:36that's less common but still a
6:39possibility some tubal pregnancies we
6:42treat with a medication called
6:44methotrexate and in other tubal
6:48pregnancies we may need to actually
6:50proceed to the operating room to do a
6:53surgery to remove the pregnancy
6:55oftentimes that can be done in a
6:57minimally invasive fashion with just
6:59very small incisions and little video
7:03cameras I'm not going to get into the
7:07full details about ectopic pregnancy per
7:10se but that just very briefly is sort of
7:13an overview of what might happen if we
7:17were worried that there might be a tubal
7:19pregnancy with someone who's gotten
7:22pregnant with an IUD in place what are
7:25the signs to look out for if you think
7:28that you might be pregnant with an IUD
7:30in place in terms of just speaking of
7:34ectopic pregnancy things that we might
7:36look out for would be pain on one side
7:39of the or the other of the lower abdomen
7:41if we were worried that things had
7:44progressed to the point of progressed to
7:47the point of where there was risk of a
7:50tubal rupture or bleeding we'd look out
7:52for any signs of dizziness
7:54lightheadedness pain in the right
7:57shoulder tip or either shoulder tip
8:00which can be due to what we call
8:04referred pain bleeding can be a sign as
8:08well in terms of just looking at
8:12symptoms of pregnancy in general if
8:13we're worried about an intrauterine
8:15pregnancy some of the symptoms could be
8:17nausea breast tenderness irregular
8:21bleeding unfortunately many of these
8:24symptoms are also potential symptoms
8:27that can happen as part of the
8:30adjustment phase of an IUD having been
8:33inserted or maybe although rarely but
8:36maybe side-effects with regards to IUD
8:39use the bottom line is if someone is
8:42worried the
8:43they might be pregnant then definitely
8:47we need to follow up with usually
8:50starting with a urine pregnancy test or
8:52even more accurately a blood pregnancy
8:55test
8:55now many women with for example the
8:59Mirena IUD or the kaileena IUD may not
9:03have a menstrual cycle at some point in
9:05time because the progesterone has
9:07thinned out the lining of the uterus and
9:09so they're not having a cycle and so in
9:11those patients I often have the question
9:13well then how am I supposed to know if I
9:16have a pregnancy with the IUD in place
9:18because my periods are gone so I
9:20wouldn't have that warning of the missed
9:23cycle so for my patients I'd say the
9:26first time that that happens where you
9:28don't have a cycle because your cycles
9:31have been getting lighter and lighter
9:32and you're not cycling on the
9:36levonorgestrel iud you can raise your
9:38yourself by doing a home pregnancy test
9:40just to be certain but thereafter if you
9:43continue to not men straight and or
9:45having almost non-existent cycles it's
9:48not actually necessary to continue to do
9:52a pregnancy test
9:53each month now in terms of what are the
9:59options if someone has has a pregnancy
10:03that's intrauterine while an IUD is in
10:06place first of all just to reiterate if
10:09it is a tubal pregnancy there is no
10:11possibility of the pregnancy safely
10:13continuing and it needs to be managed as
10:17such if someone finds that they have
10:20become pregnant with an IUD in place and
10:23it's intrauterine than we do have some
10:26options
10:26first of all in all situations
10:28regardless of how the patient decides to
10:31proceed we do attempt to remove the IUD
10:34immediately and sometimes this is
10:37possible in other situations the IUD may
10:39have migrated further up into the uterus
10:41and the strings aren't visible and we're
10:43not able to remove the IUD but if we are
10:46able to do so easily that may remove the
10:49IUD and
10:51if the patient chooses to terminate the
10:54pregnancy then obviously she would be
10:57referred to a clinic or a center where
11:01that procedure is performed in the event
11:04that the IUD hadn't been removed
11:06previously it can be removed at the time
11:08of the termination I would also note
11:11that having had one eye ud failure does
11:15not necessarily mean that you can't use
11:17an IUD again or that if you do use an
11:20IUD again that you're going to have
11:22another IUD failure and so in a patient
11:26who has a termination removal of the in
11:29place IUD it is theoretically possible
11:31to reinsert a new IUD at the time of
11:35that procedure often times in those
11:38situations we will have done additional
11:41ultrasound imaging to rule out any
11:43particular reason that may have caused
11:46the IUD failure we want to make sure
11:49that there's not some sort of uterine
11:50abnormality that may have caused the
11:53failure but as long as there's not any
11:56sort of structural cause that may have
11:59led to the IUD failure than it is
12:02possible to reinsert a new IUD at the
12:05time of termination for those patients
12:08that decide to continue on with the
12:10pregnancy it is considered a higher risk
12:13pregnancy because of the potential risks
12:16associated with having the IUD in place
12:18those risks include the risk of
12:20miscarriage the risk of preterm delivery
12:24there's a risk of preterm premature
12:26rupture of membranes some studies have
12:29shown an increased risk of low birth
12:31weight infants having said all that I
12:35have in my practice seen several
12:37patients who have gone on to have
12:39healthy term uncomplicated deliveries
12:43despite an IUD being in place and then
12:47usually what happens if the IUD hadn't
12:49previously been removed it's removed at
12:52the time of delivery usually found
12:54within the membranes or close to the
12:56placenta but we would just remove it at
13:00that time so
13:02obviously if this situation happens your
13:08obstetrician-gynecologist would be going
13:11through all of these potential increased
13:14risks with you and coming up with a plan
13:15for surveillance and watching the
13:17pregnancy a bit more closely now just to
13:21go back a step and address some of the
13:24potential reasons why might an IUD fail
13:28again it's very rare but some of the
13:31potential reasons that an IUD might fail
13:34could be IUD male positioning so if
13:37there had been an expulsion or a partial
13:40expulsion of the IUD and I did do a
13:44separate video on I you D expulsion I
13:46think that's video 24 but if there is an
13:49expulsion or a partial expulsion of the
13:51IUD and the patient isn't isn't aware
13:54that that's happened and has continued
13:56on without using back-up contraception
13:58then certainly an out of position IUD
14:02might predispose to pregnancy another
14:05situation might be if a patient has had
14:08a hormonal IUD inserted and then
14:11immediately is sexually active without
14:14backup contraception that could
14:16potentially lead to a pregnancy well a
14:19copper IUD is usually effective fairly
14:21immediately a hormonal IUDs AF Ekta v'
14:27depending on when in the menstrual cycle
14:29its inserted and so definitely as a
14:33precaution I advise patients that they
14:35should use backup contraception for at
14:37least the first week after a hormonal
14:40IUD insertion and as an extra precaution
14:43I usually say to use backup
14:46contraception right up until the
14:48follow-up visit with me usually a month
14:51later because I thought visit I also
14:53have a chance to check the IUD and make
14:55sure that there's not been any sort of
14:57expulsion another situation where
15:00someone might get pregnant with an IUD
15:02in place is if they have left the IUD in
15:05for too long and it's actual utility has
15:09expired so for example for a five-year
15:12copper IUD if the page
15:14has left it in past the five year mark
15:16and it's not using further backup
15:18contraception or similarly for a five
15:21year hormonal IUD if it's been in for
15:24too long without being replaced and the
15:27patient is continuing to be sexually
15:29active without any other form of
15:31contraception then obviously that might
15:33predispose to pregnancy
15:36another unique situation where we might
15:39find a patient ending up pregnant with
15:42an IUD in place is if the IUD is
15:46actually inserted while the patient is
15:50pregnant or just pregnant so in my
15:55practice I go to fairly extreme lengths
15:58to try to guarantee that this doesn't
16:00happen and that's why where there's any
16:03doubt in my mind based on the clinical
16:05history or the patient's menstrual
16:08history if there's any doubt as to
16:11whether or not that patient might be
16:13pregnant on the day of the IUD insertion
16:15then I actually have the patient do a
16:18blood pregnancy test so I can be certain
16:21that I'm not inserting the IUD into a
16:25pregnant or just pregnant uterus because
16:29then obviously it would be a setup
16:31potentially for a more complicated
16:33pregnancy if she did end up ultimately
16:36being pregnant with an IUD in place so
16:39so those are some of the potential
16:41explanations as to why you might have a
16:45failure of the IUD as I mentioned
16:49previously if you have experienced an
16:51IUD failure it does not necessarily
16:54preclude future are you D use it does
16:57not necessarily mean that you would
17:01potentially have a failure of the IUD in
17:03the future but I in my practice usually
17:06for those patients will do some extra
17:08imaging or specialized I you are a
17:11specialized ultrasound rather to rule
17:14out any sort of uterine anomalies or
17:17abnormalities that may have predisposed
17:20to the IUD not functioning or mount
17:24positioning of the IUD so I would want
17:26to
17:27any of those problems before we
17:28perceived with another IUD in the future
17:33so those are the main points that I
17:37wanted to cover here it's sort of a more
17:41complex topic so this was a bit of a
17:43longer video I do apologize but I hope
17:45that I've answered most of the questions
17:46out there and certainly if there are any
17:50residual questions on this topic please
17:52feel free to get in touch with me
17:55through the comments section thank you
17:58once again to Rebecca for suggesting
18:00this video topic I will end today's
18:03video as I do always by reminding you
18:06that in less than the time that it took
18:09for you to watch this video you could
18:11have had an IUD inserted the process
18:13takes about five minutes and provides up
18:16to five years of worry free
18:18contraception thanks for watching and
18:21we'll see in the next video
18:22take care

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