Let's Talk About That Viral Photo Of A Baby Holding An IUD

What really happens when IUDs fail?

You might've seen that viral Facebook post — or meme — with a photo of a newborn baby holding the mom's IUD. The post has since been deleted, but it raised a lot of questions about how likely it is to get pregnant with an IUD and what you should do if it happens to you.

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In the original Facebook post, the mother shared the photo with the caption "Mirena fail!" followed by her baby's weight and height, and a note that the "IUD was found behind the placenta." Given the last detail, the photo was most likely staged and the baby did not come out actually holding the mom's IUD.

However, the photo has already been shared thousands of times on Twitter, Instagram, and Reddit without the original source or any context — which has undoubtedly led to some confusion among people about the IUD and pregnancy.

BuzzFeed Health reached out to expert OB-GYN Dr. Jennifer Gunter, to find out more about getting pregnant with an IUD.

Yes, it can happen. It's very rare, but the failure rate of a hormonal IUD is about 0.2%.

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Unfortunately, no birth control method is 100% effective. "We know the IUD is incredibly effective but there are still failures — we even see failures with tubal ligations, and that's just because there's no completely perfect method out there," Gunter told BuzzFeed Health.

There are several kinds of hormonal IUDs, the most common ones in the US being Mirena and Skyla (a slightly smaller version). Mirena is 99.8% effective for up to five years with a failure rate of 0.2%, and Skyla is 99.6% effective for up to three years with a failure rate of 0.4%. Both options are inserted into the uterus and release a type of progestin hormone called levonorgestrel to prevent pregnancy. There's also the copper IUD, which is 99.2-99.4% effective, so the failure rate is about 0.6-0.8%.

The failure rates for IUDs are very, very small but they still exist — meaning some people just get unlucky. A 2011 literature review from the American Congress of Obstetricians and Gynecologists (ACOG) found 36 reported cases.

"We don't know exactly why the IUD fails and some women still get pregnant," Gunter said, mainly because it hasn't been well studied.

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"It could be that it shifted or moved somewhere in her uterus where it stopped working, or since the IUD works by changing the cervical mucus, maybe her partner's sperm had some incredible strength and mucus-penetrating ability, who knows," Gunter said.

Just to clarify, we're talking about the IUD failing to prevent pregnancy while it is still successfully implanted in the uterus. This is not the same as an IUD failing to implant or "IUD expulsion," which can occur in 2-10% of women in the first year after insertion. This is why doctors recommend checking the IUD threads once a month to make sure it's in place.

If you do get pregnant with a hormonal IUD, there's a higher risk of ectopic pregnancy, infection, miscarriage, and premature delivery.

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The first risk, an ectopic pregnancy, means that the fertilized egg grows outside the uterus and the pregnancy occurs in the fallopian tubes instead. This is an emergency that requires immediate medical attention — if left untreated, ectopic pregnancy can cause internal bleeding, infertility, and even death.

If the fertilized egg successfully implants in the uterus and you continue the pregnancy with a hormonal IUD, there are different risks. These include infection or sepsis, says Gunter, and also miscarriage, premature delivery, or very rarely, death. However, just because these can happen doesn't mean they will happen.

"We do know there's a slightly higher risk of a negative outcome with the pregnancy if you still have a hormonal IUD, but we don't know how high or have any percentages because there just haven't been many studies on this yet," Gunter said. So if you have an IUD and think you're pregnant, don't panic — just go see your doctor as soon as possible.

For these reasons, doctors will often recommend removing the IUD if the strings are still visible and long enough to pull out. If not, it may be too risky to take it out.

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The World Health Organization and FDA recommend that the IUD be removed as soon as possible without an invasive procedure. According to Gunter, this means the IUD is only removed if the strings (which extend through the cervix into the vagina) are still visible and long enough to pull it out.

"During the pregnancy, the uterus will grow and move upwards, bringing the IUD and its strings along with it — so by the time many women realize they're pregnant, the IUD strings are no longer visible and it's too late," Gunter said. If the IUD has already moved up into the uterus and the strings are no longer visible, it just has to be left in there.

"Removing it at this point could rupture the sac and induce a miscarriage — so we just leave it and we'll monitor the pregnancy closely — doing frequent ultrasounds and checking for signs of infection or any problems," Gunter said.

If the IUD is left in place during the pregnancy, the hormones probably won't harm the fetus.

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"If the IUD is still in the uterus during pregnancy, that doesn't mean the baby is bathing in hormones — it's still contained in a sac and the IUD is outside," Gunter said. It isn't exactly known whether the hormones will cross the placenta barrier, she said, but if they do it isn't a known risk to the fetus.

"We know that exposure to the hormones from the IUD probably won't do any harm to the fetus. Many women accidentally take birth control with the same hormones (just not localized) for half or the entirety of their pregnancy and it doesn't seem to have an effect," Gunter said.

The ACOG literature review also examined fetal exposure to levonorgestrel from a retained hormonal IUD and found that the amount of hormones is equal to or less than that from a combined contraceptive pill and is "unlikely to have any effect on an ongoing pregnancy." Mirena's website states that "it is not known if Mirena can cause long-term effects on the fetus if it stays in place during a pregnancy."

All that being said, it's still super rare for this to happen.

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"This shouldn't frighten people away from the IUD because it's so rare, and for the overwhelming majority of women, the IUD is an incredibly effective, reliable, safe birth control method," Gunter said. If you have an IUD and you're worried about becoming pregnant, you can always call your doctor or healthcare provider.

Otherwise, don't panic or freak out when stories like these come out. Remember, no birth control method is 100% effective at preventing pregnancy (as this quiz shows), but the failure rate of IUDs is still ridiculously small, which is why they're a great option if you don't want to get pregnant.

Birth control is a pretty personal decision and it really depends on your personal health and needs. So click here to find out which birth control method might be the right choice for you and print out our handy-dandy checklist before you meet with your doctor.