What Are Your Chances of Pregnancy After Tubal Removal?

Your chances of getting pregnant after tubal removal depend almost entirely on whether one tube or both were removed and whether you pursue assisted reproduction. After a bilateral salpingectomy, where both fallopian tubes are taken out, spontaneous pregnancy is nearly impossible but not quite zero. After a unilateral salpingectomy, where only one tube is removed, you can still conceive naturally through the remaining tube, though your odds per cycle are somewhat reduced. The picture gets more interesting when you factor in why the tube was removed, because in some cases the surgery itself can improve fertility outcomes down the line.

Bilateral Removal Makes Natural Pregnancy Vanishingly Rare

When both fallopian tubes are removed, the physical pathway for an egg to meet sperm is gone. The ten-year failure rate for tubal sterilization by salpingectomy techniques is roughly 0.02%, and a 2022 systematic review found only four documented cases of spontaneous pregnancy occurring inside the uterus after total bilateral salpingectomy in the entire medical literature.¹ Those numbers tell you that while the body can occasionally find a workaround, you should not plan around it.

The few spontaneous pregnancies that have occurred after complete bilateral salpingectomy are thought to involve tiny fistulous tracts, essentially microscopic channels that form at the cornual stump where each tube once connected to the uterus. An egg released by the ovary could theoretically travel through the abdominal cavity, enter the uterus through one of these tracts, and be fertilized there or nearby. One case report noted that such a tract could be too small to detect even on imaging.² These events are medical curiosities, not realistic expectations.

When Only One Tube Is Removed

If you had a unilateral salpingectomy, usually because of an ectopic pregnancy or a diseased tube, you still have one functioning fallopian tube. In theory, you ovulate from each ovary roughly in alternation, so you have a viable pathway about half the time. In practice, the remaining tube can sometimes pick up eggs from the ovary on the opposite side, a phenomenon called transperitoneal migration. Your per-cycle odds are lower than someone with two healthy tubes, but natural pregnancy is far from unusual.

Research on intrauterine insemination in women with one blocked or absent tube found pregnancy rates per cycle of about 17%, which was comparable to rates seen in women being treated for unexplained infertility.³ That suggests having a single healthy tube is not as large a disadvantage as many people assume, particularly if the remaining tube is in good condition. The health of that remaining tube matters a great deal. If it has adhesions or other damage, the outlook is less favorable.

IVF After Bilateral Salpingectomy

For women who have had both tubes removed, in vitro fertilization is the standard path to pregnancy. IVF bypasses the fallopian tubes entirely: eggs are retrieved directly from the ovaries, fertilized in the lab, and embryos are transferred into the uterus. The tubes play no role in that process, which is precisely why IVF exists for this situation.

A common worry is that having the tubes removed might damage the ovaries or reduce the pool of eggs available for IVF. A meta-analysis pooling results from multiple studies found no statistically significant change in a key marker of ovarian reserve after salpingectomy.⁴ That held true regardless of whether one or both tubes were removed, and regardless of the patient’s age (as long as they were under 40). A separate study looking specifically at surgical technique found that even when the surgeon removed a wider margin of surrounding tissue alongside the tube, ovarian reserve markers stayed the same.⁵

A broader systematic review did note that while most studies showed no harm, a small minority found temporary drops in hormone levels around three months after surgery.⁶ The consensus, though, is reassuring: tubal removal itself does not meaningfully compromise your egg supply or your response to fertility medications during IVF.

Age Makes a Bigger Difference Than the Surgery

One of the clearest findings in this area is that age is a much more powerful predictor of IVF success than whether you had a salpingectomy. A retrospective study comparing IVF outcomes in women who had undergone salpingectomy versus those who had not found no significant differences in live birth rates, clinical pregnancy rates, or miscarriage rates between the two groups.⁷ The study did observe lower follicle counts in women aged 35 to 39 who had undergone salpingectomy, but that difference did not appear in women under 35 and, crucially, it did not translate into worse pregnancy outcomes for either age group.

What the data consistently show is that your age at the time of IVF matters more than the surgical history. A 32-year-old woman who had both tubes removed for ectopic pregnancies has a substantially better IVF prognosis than a 42-year-old in the same situation, simply because egg quality and quantity decline with age regardless of tubal status.

When Tubal Removal Actually Improves Your Chances

Here is where the story takes a counterintuitive turn. If your tubes were removed because of hydrosalpinx, a condition where a blocked tube fills with fluid, the surgery may have actively improved your fertility rather than limiting it. A diseased, fluid-filled tube is not just non-functional; it is actively harmful. The fluid can leak into the uterus, creating a hostile environment for an embryo trying to implant.

A landmark Scandinavian trial randomized women with hydrosalpinx to either have the affected tube removed before IVF or to proceed directly to IVF without surgery. Delivery rates were about 29% in the salpingectomy group compared with roughly 16% in the group that skipped surgery. The benefit was especially dramatic in women with visible hydrosalpinx on ultrasound: delivery rates jumped from about 18% to 40% after salpingectomy.⁸ Multiple studies have since confirmed that removing a diseased tube before IVF can increase pregnancy rates.⁹

A more recent network meta-analysis looking at various hydrosalpinx treatments found that the evidence for salpingectomy improving clinical pregnancy rates remained solid, even though the picture was muddier when it came to the ultimate measure of live birth rates.¹⁰ The bottom line is that if hydrosalpinx was the reason for your surgery, you may be in a better position for IVF than you were before the tubes came out.

How Removing a Diseased Tube Helps the Uterine Lining

The mechanism behind this improvement goes beyond simply stopping fluid from dripping into the uterus. Research has shown that hydrosalpinx fluid disrupts molecular signals in the uterine lining that are critical for embryo implantation. One study found that women with hydrosalpinx had significantly lower levels of a key implantation protein in their endometrium. After salpingectomy, expression of that protein increased roughly 15-fold, essentially restoring the lining to a state similar to that of fertile women without tubal disease.¹¹

Another study found that removing the hydrosalpinx reduced markers of chronic inflammation in the uterine lining, bringing them down to levels comparable to those in fertile controls.¹² So the benefit is two-pronged: you stop the toxic fluid from reaching the uterus, and you allow the lining to heal from the chronic damage that fluid was causing. This is why fertility specialists routinely recommend removing hydrosalpinges before attempting IVF.

Timing Your IVF Cycle After Surgery

If you have recently had a salpingectomy, you may wonder how long to wait before starting IVF. A study comparing reproductive outcomes across different waiting intervals after tubal surgery found no significant differences in implantation rates, clinical pregnancy rates, or live birth rates whether women started their frozen embryo transfer cycle sooner or later after surgery.¹³ Most clinicians suggest waiting at least one or two menstrual cycles for physical recovery, but there does not appear to be a fertility penalty for moving forward relatively quickly once you have healed.

Ectopic Pregnancy Risk Does Not Fully Disappear

One of the more unsettling facts about salpingectomy is that while it is the preferred treatment for ectopic pregnancies, it does not completely eliminate the risk of another one. Case reports exist of women experiencing ectopic pregnancies even after both tubes have been removed.¹⁴ These are exceedingly rare, but they can occur in the cornual stump, in the abdominal cavity, or even in the ovary itself.

For women who had one tube removed for an ectopic and still have the other, the condition of that remaining tube is a major factor. Research using diagnostic examination of the surviving tube found that women with adhesions inside the tube had higher rates of repeat ectopic pregnancy.¹⁵ If you have had an ectopic pregnancy treated with salpingectomy, your doctor may want to evaluate the health of your remaining tube before you try to conceive again naturally.

Tubal Ligation Reversal Versus IVF — a Different Situation

It is worth distinguishing tubal removal from tubal ligation, because the two present very different fertility scenarios. With ligation, the tubes are clipped, banded, or cut but not fully removed, which means surgical reconnection (anastomosis) is sometimes possible. With complete salpingectomy, there is no tube left to reconnect, making reversal surgery irrelevant. IVF is the only assisted reproduction option.

For women who had a ligation rather than a full removal, cost-effectiveness analyses have found that surgical reversal tends to be more affordable per ongoing pregnancy than IVF for women under about 41, while IVF becomes the more cost-effective choice at older ages.¹⁶ If you are unsure whether your procedure was a ligation or a salpingectomy, your operative report will specify. The distinction matters enormously for your options going forward.

The Rise of Prophylactic Salpingectomy and What It Means for Future Fertility

A growing trend in gynecological surgery is the “opportunistic” or prophylactic salpingectomy, where surgeons remove the tubes during an unrelated pelvic surgery (like a hysterectomy or cesarean section) or in place of traditional tubal ligation for sterilization. The motivation is cancer prevention: research from Scandinavian and North American populations has found that women who had their tubes removed showed reduced odds of developing ovarian cancer.¹⁷ Many of the most aggressive ovarian cancers appear to originate in the fallopian tubes, which is why professional societies in several countries now recommend considering salpingectomy over traditional ligation when permanent contraception is desired.

This shift has real implications for women who might change their minds about having children later. After a tubal ligation, reversal surgery is an option. After a prophylactic salpingectomy, it is not. The sterilization effectiveness appears similar: a meta-analysis found that salpingectomy was at least as effective as ligation for preventing pregnancy, with a trend toward even fewer failures.¹⁸ If you are considering this procedure and there is any chance you might want biological children in the future, understanding that IVF would be your only path is essential information to have before the operating room.

Salpingectomy After an Ectopic Pregnancy and Its Emotional Weight

For many women, the question of fertility after tubal removal is not hypothetical. It arises urgently after an ectopic pregnancy, often during a period of grief and medical crisis. Research has acknowledged that women who have experienced ectopic pregnancy may face a slightly reduced chance of future pregnancy, particularly when salpingectomy was the treatment.¹⁹ But “slightly reduced” is not the same as “unlikely.” The majority of women who lose one tube to an ectopic pregnancy go on to conceive, either naturally through the remaining tube or with the help of fertility treatment.

The emotional aftermath can be as significant as the physical one. Anxiety about future ectopic pregnancies, grief over the lost pregnancy, and uncertainty about fertility can all compound. Early conversations with a reproductive endocrinologist can help clarify your individual prognosis and reduce the feeling of being in limbo. If you have one healthy tube, your doctor may recommend trying naturally for six to twelve months before considering interventions. If both tubes are gone, the conversation shifts directly to IVF planning.

What Actually Determines Your Individual Odds

No single number captures “your chances” after tubal removal, because the answer depends on several factors stacking on top of each other. The most significant ones include whether you lost one tube or both, your age at the time you try to conceive, the reason the tube was removed, the health of any remaining reproductive anatomy, and whether you pursue IVF. A 30-year-old who lost one tube to an ectopic pregnancy is in a fundamentally different situation than a 38-year-old who had both tubes removed prophylactically and now regrets the decision.

If you retain one healthy tube and are under 35, your odds of natural conception within a year are reasonably good, though lower than they would be with two tubes. If both tubes are gone, IVF success rates depend mainly on your age and ovarian reserve, not on the fact that your tubes are absent. National IVF success rates per cycle range from above 40% for women under 35 to below 10% for women over 42, and those numbers apply regardless of whether the patient has tubes. The surgery that removed your tubes did not take your eggs with it, and that is the fact worth holding onto.