If the thread of IUCD is not visible, the next step is (LQ)
a. The next best step is ultrasound abdomen as it would reveal if the Cu-T is in situ or expelled and if in situ whether it is in uterus or anywhere else in the abdomen.
b. X-Ray was done earlier but now with ultrasound available it is a better investigation.
c. If it is located in the uterus then a curettage can be attempted to remove the IUCD as an office procedure.Hysteroscopy is an invasive technique that will require anaesthesia and should be reserved for cases were uterine curettage or sounding does not help.