Hysteroscopic Retrieval of Retained and Fractured Copper Intrauterine Devices: A Case Series of Three Patients and Literature Review

This case series describes the hysteroscopic management of retained and fractured copper intrauterine devices (IUDs) in three patients treated at a tertiary gynaecology unit between January 2025 and August 2025, all presenting with missing IUD threads or a retained copper T (CuT) fragment following prior IUD use of variable duration. Patient ages ranged from 36 to 46 years; all were multiparous (P2L2 or P2L2A2), and two of the three had a history of prior caesarean section. Presentations comprised two retained isolated CuT arms following incomplete office removal (one with partial myometrial embedding), both in women with prior caesarean section and, in the most complex case, a Level IIIc fractured CuT with two myometrially embedded fragments in the right fundocornual region requiring ultrasound-guided hysteroscopy and resectoscopic excision following failed prior blind attempts at a peripheral facility. All three devices were successfully retrieved via hysteroscopy, with the procedural approach escalating from simple grasper-based retrieval to resectoscopic excision under real-time ultrasound guidance based on the degree of embedding. There were no major intraoperative or postoperative complications. This series reinforces that hysteroscopy, appropriately matched to the complexity of embedding, is an effective minimally invasive approach for retained and fractured IUDs and that pre-procedural imaging, prior caesarean section history, and IUD dwell time are important determinants of procedural planning.