To evaluate the efficacy of ultrasound-guided extraction of a ‘lost’ intrauterine device (IUD) with an endoscopic forceps. Women aged 22–63 years with ‘lost’ IUD, defined as indiscernible string in external cervical os were enrolled in the study between 2002 and 2004. Under transabdominal ultrasound guidance an endoscopic forceps was introduced in the uterine cavity in order to remove the IUD. No antibiotics were used pre or after the removal. There was a questionnaire applied just after the procedure to evaluate pain, and a telephone interview 7 days after the procedure to asses the complication rate. 124 women who's IUD could not be removed from the uterine cavity because of an indiscernible string were referred for a trial to our unit. All patients had used a plastic, copper-releasing IUD. The main reason for removal was pelvic pain. The average time for the removal was 3.8 minutes (1–11 min) with a success rate of 96.8% (120/124). The patients did not found the procedure especially uncomfortable or painful and reported a high rate of satisfaction (97.3%). There were 3 patients with complications (1.6%). 2 vagal reactions just after the procedure with a quick recovery, and 1 pelvic inflammatory disease treated with antibiotics for a week. Ultrasound-guided extraction of lost intrauterine devices is a simple and safe procedure that may be performed before more invasive measures are attempted.