Without fallopian tubes, conceiving naturally is not a realistic possibility. The tubes are where sperm meets egg, and without them, that encounter simply cannot happen on its own. But “no tubes” does not mean “no pregnancy.” In vitro fertilization bypasses the tubes entirely, and the success rates for women with tubal-factor infertility are solidly encouraging. The real picture is more nuanced than a flat yes or no, though, because the reason your tubes were removed, your age, and your ovarian health all shape what comes next.
Why Fallopian Tubes Are Normally Essential
Fallopian tubes do more than serve as a hallway between ovary and uterus. After an egg is released, tiny hair-like projections at the open end of the tube sweep it inward. Sperm travel up through the uterus and into the tube, and fertilization happens inside it. The tube then gently moves the fertilized egg toward the uterus over the course of several days, giving the embryo time to develop before implanting in the uterine lining. Remove both tubes and there is no place for this process to unfold.
IVF was originally developed precisely to solve this problem. The technique collects eggs directly from the ovaries, fertilizes them in a lab, and transfers the resulting embryo into the uterus, skipping the tubes altogether. Tubal-factor infertility accounts for roughly 30 to 35 percent of female infertility cases, making it one of the most common reasons people turn to IVF in the first place.1Journal of Obstetrics, Gynecology and Cancer Research. A Comparison of Fertility Rates in Women Undergoing IVF with a Tubal Factor with Surgery, Tubal Factor Infertility Without Surgery, and Unexplained Infertility
Can You Get Pregnant Naturally After Bilateral Salpingectomy
If both tubes have been completely removed, spontaneous pregnancy has essentially never been documented in the medical literature. One review noted that while the pregnancy rate after tubal ligation (where the tubes are cut or blocked but left in place) is around 0.8 percent, inadvertent pregnancy after full salpingectomy has yet to be reported, aside from rare cornual pregnancies that occurred during IVF treatment.2Journal of Gynecologic Oncology. Ovarian cancer risk reduction through opportunistic salpingectomy A cornual pregnancy is one that implants in the tiny segment of the tube that passes through the uterine wall itself, and it is an extremely rare event rather than a viable route to a healthy pregnancy.
You may have come across news stories or forum posts claiming someone got pregnant after having “both tubes removed.” These deserve scrutiny. A 2024 case report investigated exactly this scenario: a woman became pregnant after what was believed to be a complete bilateral salpingectomy. When doctors examined her during a subsequent surgery, they discovered that one tube had not actually been fully removed. The pathology reports from the original procedure showed the left tube measured only 4.6 cm while the right was 9.5 cm, and a 3 to 4 cm remnant of tubal tissue remained attached to the uterus on the left side.3PubMed Central. Spontaneous intrauterine pregnancy after tubal sterilization: A case report In other words, what looked like a complete removal in the operative notes was actually a partial salpingectomy. Adhesions around the tube had made the original surgery more difficult, and a functional remnant was left behind without the surgeon realizing it.
This finding matters because it underscores a practical reality: the handful of “miracle pregnancies” after salpingectomy likely reflect incomplete surgery rather than some mysterious biological workaround. If your tubes were genuinely and fully removed, confirmed by pathology, natural pregnancy is not something to plan around.
IVF Success Rates When Tubes Are Missing
The encouraging news is that IVF works well for tubal-factor infertility. One large analysis reported an overall delivery rate per embryo transfer of about 29 percent for patients whose sole or primary issue was tubal disease. Cumulative pregnancy rates climbed with repeated cycles: roughly 32 percent after the first cycle, 59 percent after two, 70 percent after three, and 77 percent after four. The study concluded that more than 70 percent of women with tubal-factor infertility would achieve a live birth within four IVF cycles, results that compared favorably with the best outcomes from reconstructive tubal surgery.4PubMed. In vitro fertilization versus tubal surgery: is pelvic reconstructive surgery obsolete?
Another study found a live birth rate of about 67 percent for the tubal-factor group after IVF, which was lower than the roughly 79 percent seen in couples with unexplained infertility but still represented strong odds.5Human Reproduction. Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility The takeaway is that missing tubes do not appear to meaningfully compromise your chances with IVF compared to other common reasons people undergo the procedure.
Age, however, matters a great deal. One study tracking IVF outcomes by age bracket in patients with tubal factor found the numbers dropped steeply after the mid-thirties: pregnancy rates were about 48 percent for women under 30, 44 percent for those 30 to 34, 28 percent for 35 to 38, 20 percent for 39 to 40, and 9 percent for 41 to 42.4PubMed. In vitro fertilization versus tubal surgery: is pelvic reconstructive surgery obsolete? These age-related declines are driven by egg quality rather than anything about the tubes themselves, but they shape the conversation about timing if you are considering IVF after salpingectomy.
Does Removing Tubes Hurt Your Ovarian Reserve
A common worry is that salpingectomy damages the ovaries or reduces the pool of eggs available for future IVF. The fallopian tubes and the ovaries share part of their blood supply, so it is biologically plausible that surgery near the ovary could affect blood flow and, in turn, ovarian function. Fortunately, the evidence so far is largely reassuring.
A systematic review and meta-analysis pooling results from multiple studies found no statistically significant change in circulating AMH levels (a key marker of egg reserve) after salpingectomy. This held true whether the analysis looked at before-and-after measurements within the same women or compared salpingectomy patients with controls, and it remained consistent across subgroups based on whether one or both tubes were removed, the patient’s age (under 40), or the type of lab test used.6PubMed. Ovarian reserve after salpingectomy: a systematic review and meta-analysis A randomized trial comparing women who had their tubes removed during hysterectomy with those who did not found that AMH levels dropped in both groups at three months, but the rate of decline was the same regardless of whether salpingectomy was performed.7PubMed Central. Effects of salpingectomy during abdominal hysterectomy on ovarian reserve: a randomized controlled trial
That said, the picture is not entirely settled. A more recent systematic review concluded that while short-term ovarian function appears unaffected, concerns remain about potential long-term effects because of the inherent risk of disrupting blood supply during surgery.8PubMed Central. The Impact of Opportunistic Salpingectomy on Ovarian Reserve: A Systematic Review And one retrospective study found that women under 35 who had prior salpingectomy retrieved fewer eggs during IVF, with the effect most pronounced in those who already had lower-than-ideal ovarian reserve to begin with.9PubMed Central. Prior salpingectomy impairs the retrieved oocyte number in in vitro fertilization cycles of women under 35 years old without optimal ovarian reserve: A retrospective study Other studies, though, found no significant differences in oocytes retrieved, fertilization rates, or clinical pregnancy rates between salpingectomy patients and controls.10Journal of Minimally Invasive Gynecology. Ovarian Response and in Vitro Fertilization Outcomes After Salpingectomy: Does Salpingectomy Indication Matter? 11PubMed. Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal
The practical reading: if you are heading into IVF after salpingectomy, your egg supply is probably fine, especially in the short to medium term. If you already had signs of reduced ovarian reserve before surgery, the impact could be more meaningful. Your fertility specialist will test AMH and antral follicle count before starting treatment to get a clear baseline.
When Removing Tubes Actually Improves IVF Outcomes
Here is a scenario that surprises many people: sometimes removing a damaged tube before IVF is the best thing you can do for your chances. The condition at the center of this is called hydrosalpinx, where a blocked tube fills with fluid. This fluid can leak backward into the uterus, creating a hostile environment for an embryo trying to implant. Research has shown that the presence of hydrosalpinx decreases both pregnancy and implantation rates compared to women who have tubal disease but no fluid buildup, and that the fluid itself appears to be toxic to developing embryos.12PubMed. The significance of hydrosalpinx in in vitro fertilization
Removing the affected tube or tubes before starting IVF brings success rates back in line with those of patients who never had hydrosalpinx. This is why salpingectomy is now routinely recommended for women with hydrosalpinx who plan to pursue IVF. Hydrosalpinx can also develop after other pelvic surgeries; one estimate found it occurs in up to 30 percent of women after hysterectomy.13Oxford Academic (Human Reproduction). The post-reproductive Fallopian tube: better removed? So the removal of tubes is not always a barrier to pregnancy. In certain cases, it is actively clearing the way.
What About Tubal Reversal Surgery
If your tubes were tied or clipped rather than fully removed, reversal surgery is sometimes an option, and it is worth understanding how it stacks up against going straight to IVF. A study following patients for up to six years found that the cumulative delivery rate was about 60 percent after reversal compared to 52 percent after IVF, and the difference was not statistically significant overall. But age split the results dramatically: for women under 37, reversal led to a 72 percent delivery rate versus 52 percent with IVF. For women 37 and older, IVF pulled ahead at about 51 percent versus 37 percent for reversal.14Human Reproduction. Getting pregnant after tubal sterilization: surgical reversal or IVF? A systematic review corroborated this age-dependent pattern and also found that reversal was substantially cheaper per live birth, at roughly half the cost of IVF in younger women.15Human Reproduction Update. Tubal anastomosis after previous sterilization: a systematic review
None of this applies if your tubes have been completely removed, of course. You cannot reverse a salpingectomy. The distinction between tubal ligation and salpingectomy is critical: ligation leaves the tubes in place, so reconnecting them is at least surgically possible. Salpingectomy removes them entirely. If you are unsure which procedure you had, your operative and pathology reports will clarify. For women who have had full bilateral salpingectomy, IVF is the only established route to pregnancy using your own eggs.
Salpingectomy After Ectopic Pregnancy and Future Fertility
One of the more common reasons a tube is removed is ectopic pregnancy, where a fertilized egg implants inside the tube rather than the uterus. When this happens, surgeons have two options: remove the tube entirely (salpingectomy) or open the tube and remove just the ectopic tissue (salpingotomy), preserving the tube. A large randomized trial found that, in women who had a healthy tube on the other side, the future fertility outcomes were essentially the same regardless of which approach was used. The cumulative ongoing pregnancy rate was about 61 percent after salpingotomy and 56 percent after salpingectomy, a difference that was not statistically significant.16The Lancet. Salpingotomy versus salpingectomy in women with tubal ectopic pregnancy (ESEP): an open-label, multicentre, randomised controlled trial
This is reassuring if you lost one tube to an ectopic pregnancy: one functioning tube is enough for natural conception. An egg released from either ovary can be picked up by the remaining tube, since the tube’s fringed end is mobile enough to reach across the pelvis. Losing both tubes to ectopic pregnancies is less common but does happen, particularly in women with recurrent ectopic pregnancies or severe pelvic disease. In that situation, IVF becomes the path forward.
The Age Factor in IVF After Salpingectomy
Age comes up repeatedly in this conversation because it is the single strongest predictor of IVF success, regardless of whether you have tubes. A retrospective study specifically looking at women aged 35 to 39 who had undergone salpingectomy found that their antral follicle counts (a measure of available eggs visible on ultrasound) were lower compared to controls of the same age. However, and this is the important part, clinical pregnancy rates, spontaneous abortion rates, and live birth rates were not significantly different between the salpingectomy group and the control group in any age bracket tested.17PubMed Central. Salpingectomy may decrease antral follicle count but not live birth rate for IVF-ET patients aged 35–39 years: a retrospective study
In practical terms, even if salpingectomy slightly reduces the number of eggs your ovaries produce during stimulation, the eggs that do develop seem to be perfectly usable. What matters far more is how old you are when you begin IVF. If you know you want to pursue pregnancy after salpingectomy, earlier is generally better, not because the surgery makes you less fertile over time, but because egg quality naturally declines with every passing year.
Sterilization Regret and the Question of Future Pregnancy
Some women who initially chose salpingectomy as a permanent form of contraception later find themselves wanting to become pregnant. This is not unusual. Research on women who underwent tubal sterilization in the United States found that roughly 28 percent reported regret afterward. Several factors predicted higher odds of regret: having had the procedure for situational reasons (relationship pressure, financial stress, health problems) rather than a clear personal decision not to have more children, and having more time pass since the surgery.18PubMed Central. Reasons for tubal sterilisation, regret and depressive symptoms Sterilization regret was also associated with depressive symptoms, adding an emotional dimension that fertility clinics increasingly recognize and address.
If you had a tubal ligation and now want to conceive, reversal surgery may be an option, especially if you are under 37. If you had a full salpingectomy, reversal is off the table, but IVF remains a viable and well-studied alternative. The emotional weight of wanting a pregnancy that feels impossible is real, and it is worth knowing that reproductive endocrinologists see patients in this exact situation regularly. The medical options are well-defined, and the outcomes are measurable. The first step is always understanding exactly what surgery was performed, which your medical records can confirm.
Prophylactic Salpingectomy and Cancer Prevention
An increasingly common reason tubes are removed has nothing to do with infertility or ectopic pregnancy. A growing body of evidence suggests that many cases of ovarian cancer actually originate in the fallopian tubes, which has led gynecologic organizations to recommend “opportunistic salpingectomy,” the removal of tubes during unrelated abdominal surgeries like hysterectomy or even cesarean sections, as a cancer-prevention strategy.2Journal of Gynecologic Oncology. Ovarian cancer risk reduction through opportunistic salpingectomy For women who have completed their families, this tradeoff is straightforward. For younger women who might want children later, the question of whether this procedure compromises future fertility naturally arises.
The data reviewed earlier on ovarian reserve and IVF outcomes is directly relevant here. The short-term evidence suggests no harm to egg supply, though long-term data is still accumulating.8PubMed Central. The Impact of Opportunistic Salpingectomy on Ovarian Reserve: A Systematic Review If you are being offered prophylactic salpingectomy and still want biological children, the conversation with your surgeon should address both the cancer risk reduction and the fact that your path to future pregnancy would run exclusively through IVF. Freezing eggs or embryos before the procedure is an option some women choose, though the necessity of doing so is debatable given the reassuring short-term data on ovarian function after surgery.