Uterine perforation is a known complication of intrauterine device (IUD) insertion. As long-acting reversible contraception use increases, the frequency of uterine perforation at the time of IUD insertion will also rise. In rare cases, the IUD can also perforate the bladder or the bowel. In this case report, we present an incidental finding of an echogenic focus on a routine nuchal translucency ultrasound, leading to the discovery of a "lost" IUD.