Insertion requires the utmost skill and sensitivity. If your doctor isn't experienced or won't disclose his or her experience, find another doctor who will, or find another contraceptive method. If the device is imbedded in the muscle, most gynecologists can remove it. Improper removal can result in perforation, however. IUDs increase your risk of PID, an infection in the upper genital tract that can cause infertility.
Recent studies show that the risk is highest in the first four months after insertion.
Basically, the infection results because the IUD needs to go through the cervix when it's inserted. The risk of infection is highest in the first four months, as bacteria transfer from the vagina to the cervix to the uterus, hitchhiking up the IUD string. Another potential risk is an ectopic pregnancy, or tubal pregnancy. If you do get pregnant with an IUD in place, an ectopic pregnancy should be ruled out. Since IUDs prevent the egg from implanting in the uterus, the egg decides to stay in the fallopian tube, which is very dangerous.