ObjectiveThis study aimed to compare removal timing, techniques, and success of malpositioned intrauterine device (IUDs) to nonmalpositioned IUDs. Study designWe performed a retrospective cohort study of IUD users with ultrasound performed between July 2014 and July 2017 within one medical system. We used Fisher exact and Wilcoxon rank-sum tests to compare clinical characteristics and IUD removal details between patients with malpositioned and nonmalpositioned IUDs. ResultsOf 1759 ultrasounds reporting the presence of an IUD, 436 described IUD malposition. Of these, 150 described the IUD as embedded and 16 as partially perforated.IUDs were more likely to be removed and removed sooner for patients with malpositioned compared with nonmalpositioned IUDs (281/436 vs 545/1323, p < 0.001 and median 17 days vs 236 days from the index ultrasound, p < 0.001). Most IUDs, malpositioned and nonmalpositioned, were removed on the first attempt (82%, 85%), by a generalist obstetrician and gynecologist (75%, 70%), using a ring forceps (73%, 65%). Most embedded and partially perforated IUDs were removed (68%, 69%), using a ring forceps (59%, 67%), on the first attempt (84%, 91%). ConclusionsMalpositioned IUDs were more likely to be removed and removed sooner than nonmalpositioned IUDs. Most IUDs, even IUDs labeled as partially perforated or embedded, were removed by a generalist obstetrician and gynecologist, using ring forceps, on first attempt. ImplicationsUltrasound findings of IUD malposition are not associated with difficult IUD removal.