Hysteroscopic IUD Removal in Turkey: taking out a lost or embedded coil safely, under direct vision

What does a "lost" or embedded IUD actually mean?

A lost IUD is a coil whose strings can no longer be seen or felt at the cervix, even though the device itself is usually still inside the uterus. The IUD is one of the most widely used reversible contraceptives, with an estimated 180 million users worldwide, so this situation is encountered fairly often in practice. Missing or shortened strings are reported in roughly 5 to 18 percent of removals, and behind them the device may simply have its threads curled up, or it may have embedded into the muscle wall. Far less commonly it has perforated the wall and moved beyond the uterus, which is why the first job is always to find out exactly where it sits.

What are the signs that something is wrong with your coil?

The most common sign is simply that you can no longer feel the strings, but an embedded or malpositioned coil can also cause irregular bleeding, pain or cramping. Many displaced devices give few or no symptoms at all — in some series as many as 30 percent of perforations are silent — so the absence of pain does not guarantee the coil is in place. New or persistent pelvic pain, unusual bleeding, or an unexpected pregnancy after the strings disappear are all reasons to have the device checked. The reassuring point is that checking is straightforward and starts with a simple examination and a scan.

Source: American College of Obstetricians and Gynecologists (ACOG), clinical guidance on long-acting reversible contraception

Why do the strings disappear or the coil become embedded?

Strings most often "disappear" simply because they curl up into the cervical canal, but a device can also work its way into the uterine wall over time. Embedding and migration are more likely when the coil was placed soon after a caesarean or during breastfeeding, when the uterus is soft or scarred. A weakened scar from a previous caesarean or myomectomy is a recognised reason a device can gradually move into or through the wall. None of this means anything was done wrong; it is a known, if uncommon, behaviour of intrauterine devices.

Source: European Society of Human Reproduction and Embryology (ESHRE), guidance on intrauterine contraception and complications

Is it dangerous to leave a lost or embedded IUD?

Leaving a lost device that has simply retracted its strings is rarely an emergency, but an embedded or perforated coil should not be ignored. A device stuck in the wall can cause ongoing bleeding or pain, and one that has perforated into the abdomen can, rarely, reach the bowel or bladder and cause serious problems. There is also the practical issue that a displaced coil may no longer protect against pregnancy reliably. For these reasons the sensible course is to locate the device and remove it in a planned, unhurried way rather than to wait and hope.

How is a lost IUD located before removal?

Finding the device before any attempt to remove it is the step that keeps the procedure safe. The first move is to check the cervical canal for retracted strings with a fine brush or hook; if they cannot be found, a transvaginal ultrasound is used and locates the coil inside the uterus in the large majority of cases. When the device cannot be seen in the uterus, an abdominal X-ray or other imaging confirms whether it has perforated and where it now lies. This mapping decides everything that follows — whether a simple hysteroscopic removal is enough, or whether a laparoscopic approach is required.

Why hysteroscopy instead of a blind pull in the clinic?

Hysteroscopy is preferred for a lost or embedded coil because it lets the device be seen and removed under direct vision, rather than grasped blindly. A blind attempt with forceps can succeed in many simple cases, but when the device is embedded it can fail, break off a fragment, or injure the uterine wall. Removing the coil under hysteroscopic vision is highly effective — reported as successful in around 97 percent of cases in published experience — and lets the surgeon confirm the cavity is completely empty afterwards. For a device with missing strings or one fixed in the wall, seeing what you remove is what makes the difference.

Source: Journal of Minimally Invasive Gynecology, experience with hysteroscopic removal of retained intrauterine devices

How is the hysteroscopic removal actually done?

Hysteroscopic IUD removal is a short, incision-free procedure carried out through the natural passages. A thin, lit telescope is passed through the cervix, the uterine cavity is gently opened with a saline solution so every surface is visible, and the device is grasped at the junction of its arms and stem and eased out under direct vision. The whole removal usually takes only about 10 to 30 minutes and is done with light or general anaesthesia depending on how deeply the coil is embedded. Once the device is out, we inspect the cavity to confirm no fragment has been left behind.

What happens if the IUD has perforated the uterine wall?

When a device has perforated and lies partly or fully outside the uterus, it is removed by laparoscopy rather than through the cervix. Perforation is uncommon, reported at roughly 1.3 per 1,000 insertions, but it must be ruled in or out before removal because the route of surgery depends on it. A coil that has reached the abdominal cavity is retrieved with keyhole surgery, and where it has approached the bowel or bladder a careful, planned procedure is essential. Imaging beforehand is exactly what allows this decision to be made calmly rather than discovered mid-procedure.

Will removal affect my fertility?

For the great majority of women, fertility returns to normal once the device has been removed and the lining has healed. An IUD is a reversible method by design, and a gentle, complete removal under direct vision helps protect the endometrium and reduces the small risk of scar tissue forming inside the cavity. Where an embedded device has caused inflammation or a fragment has been retained, removing all of it cleanly is what most reliably preserves future fertility. If you are planning a pregnancy, this can be discussed at the same visit so the timing fits your goals.

Source: Royal College of Obstetricians and Gynaecologists (RCOG), guidance on intrauterine contraception

How safe is hysteroscopic IUD removal?

Hysteroscopic IUD removal is a low-risk procedure, and serious complications are uncommon in experienced hands. Minor cramping and light bleeding for a day or two are normal, while injury to the uterine wall or infection each occur in well under 1 percent of cases; across procedures our overall complication rate sits at around 2 percent. Because the device is removed under direct vision, the risk of leaving a fragment or causing a blind injury is much lower than with an unguided pull. With careful technique and imaging beforehand, the procedure is both safe and reliable.

What is our approach to a lost or embedded IUD?

Our approach is simple: locate the device precisely first, remove it under vision, and confirm the cavity is clean before we finish. We always map the coil with ultrasound before any attempt, because this is what tells us whether a hysteroscopic removal is enough or whether the device has perforated and needs laparoscopy. We remove embedded coils gently to protect the lining and your fertility, and we check for and retrieve any fragment rather than assume the device came out whole. As Associate Professor Dr. Cengiz Andan and our team, we also discuss with you, in the same visit, whether to place a new device or move toward a pregnancy, so the plan fits where you are in your life.

Why does experience matter for a difficult coil?

The value of an experienced surgeon shows most clearly with the difficult coil — the one that is embedded, fragmented or has perforated. Associate Professor Dr. Cengiz Andan brings 18 years of experience and more than 2,000 laparoscopic operations, which matters because the same surgeon can move from a hysteroscopic to a laparoscopic approach if the device turns out to have perforated. A complication rate kept low, at around 2 percent, reflects the value of high surgical volume when a removal is not straightforward. At the same time, we are clear that every procedure carries some risk and that findings can change once the cavity is seen directly.

How does recovery and home follow-up work?

Recovery after a hysteroscopic IUD removal is quick, because there is no incision to heal. Most women go home the same day and return to normal activity within a day or two, with light spotting and mild cramping for a few days being entirely normal. The question many ask is what happens after they fly home: if a problem arises, we remain reachable, coordinate with your doctor at home, and continue the follow-up remotely. Your operative note and findings are prepared so your own physician can take over your care without gaps.

Home country or Turkey — what is the difference?

For removing a lost or embedded coil, the difference between your home country and Turkey lies not in quality but in access and cost. The same hysteroscopic technique, the same imaging and the same international guidelines apply in both; the gap comes from the exchange rate and lower operating costs, which lower the price without lowering the standard. For many women there is a second difference that matters: completing the whole process quickly, with one responsible surgeon who can switch to laparoscopy if needed, instead of waiting months for a referral.

How does the process, stay and follow-up work from abroad?

For women coming from abroad, the process starts digitally before any travel and is completed during a short stay in Turkey. You first share your history and any imaging, then discuss the plan and an approximate cost in an online pre-consultation. When the removal is scheduled, the visit is usually short, since the procedure itself is quick and recovery is fast; flying home is generally possible within a few days. Your report and findings are prepared in a form you can hand to your doctor at home, and the follow-up continues remotely.