What happens if I get pregnant while on Accutane?

If you become pregnant while on Accutane or one of its generic equivalents, birth defects are almost a certainty. Retinoid birth defects usually involve ectodermal structures and the brain and eyes are usually most affected. The risk of defects is zero if you discontinue for at least one menstrual cycle before becoming pregnant. The I-Pledge program, while an inconvenience, assure that you are adequately informed of the risks.

Flipper-limbed babies, microcephalus (small heads), tiny or missing ears, tiny eyes, blind, heart defects, cleft palate, severe retardation, vascular malformations and kidney problems.
This is the reason for the iPledge system. It has been designed to try to ensure the terrible malformations do not happen. The iPledge system mandates two means of birth control and monthly pregnancy tests.