Pregnancy After Fallopian Tube Removal: What IVF Can and Cannot Do
Key Takeaways
Removing both fallopian tubes ends the natural route to conception; removing one does not necessarily do so. IVF bypasses the tubes entirely, and in women with a fluid-filled tube, treatment before IVF probably improves the chance of a clinical pregnancy. Completely removed tubes do not grow back, and the evidence on ovarian reserve after the operation is mixed rather than settled.
Key evidence: Cochrane - surgical treatment for tubal disease before IVF (2020) Kobayashi et al. - effect of salpingectomy on ovarian reserve
On this page
- Why a tube gets removed
- Can you get pregnant without fallopian tubes?
- Does removing the tube improve IVF chances?
- Do fallopian tubes grow back?
- Pregnancy with one tube
- Does the operation affect ovarian reserve?
- Dr. Aksoy’s Approach
- What to expect afterwards
- FAQ
- Sources
Why a tube gets removed
Tubal disease accounts for about 20% of infertility cases.[1] A tube may be removed when it is badly damaged or full of fluid. Removal may also follow an ectopic pregnancy, or be safer than leaving the tube in place.
A common reason is a hydrosalpinx — a blocked tube filled with fluid. If it connects with the womb, fluid may drain into the cavity. This can reduce the chance of a clinical pregnancy with IVF.[1,2]
Tubes are also removed during other surgery or for sterilisation. The reason for removal affects what comes next.
Can you get pregnant without fallopian tubes?
With both tubes completely removed, pregnancy is possible through IVF, not through the usual natural route.
For natural conception, a tube must collect the egg. Egg and sperm usually meet there, and the tube then carries the early embryo to the womb. Without tubes, that route is closed.
IVF does not rely on the tubes. Eggs are collected directly from the ovaries, fertilisation takes place in the laboratory, and an embryo is placed into the uterus through the cervix.
Complete removal takes away the tubal route to natural conception, but leaves the ovaries and uterus in place for IVF.
Does removing the tube improve IVF chances?
For hydrosalpinx, the evidence suggests that it does, with an important limitation.
A Cochrane review of 11 trials in 1,386 women looked at tubal surgery before IVF or ICSI.[1] Removing the tube probably raises the clinical pregnancy rate compared with no surgery. The risk ratio was 2.02 (95% CI 1.44 to 2.82; four trials, 455 women; moderate-quality evidence). The review gives a useful example. If the rate is about 19% without surgery, the estimate after removal is between 27% and 52%.
Closing the tube near the womb instead of removing it may also help. The risk ratio was 3.21 (95% CI 1.72 to 5.99; two trials, 209 women), but the evidence was low quality.[1] Direct comparisons were too weak to show which method is better.
No trial in that review reported live birth for salpingectomy versus no surgery. Clinical pregnancy matters, but live birth is the more definitive outcome. The review’s authors also noted that none of the studies reported long-term fertility outcomes. The evidence therefore supports an increase in clinical pregnancy, but it does not establish a higher live-birth rate.[1]
Do fallopian tubes grow back?
No. A removed tube does not regenerate. Salpingectomy and tubal ligation are different operations:
| Operation | What happens to the tube | Can it reopen? |
|---|---|---|
| Salpingectomy | The tube is removed | No — there is nothing left to rejoin |
| Tubal ligation | The tube is cut, tied or clipped, but stays in place | It may sometimes be surgically reversed.[2] |
If you have been told that a tube may have reopened, first confirm whether the operation was a salpingectomy or a tubal ligation. The terms are not interchangeable.
If a scan or operation report mentions a tubal remnant, ask your surgeon what was removed and what remains, particularly if the operation was for an ectopic pregnancy.
Pregnancy with one tube
Having one tube is clinically different from having none.
If the remaining tube is open and healthy, natural conception is possible. Ovulation does not follow a fixed left–right pattern.[3] In a cohort of pregnancies after unilateral salpingectomy, about one-third followed ovulation from the ovary opposite the remaining tube, showing that the remaining tube can sometimes collect an egg from the other side.[4] The study did not measure how this changes the overall chance of conception.
What matters more is the state of the tube you still have and the rest of the picture: age, ovarian reserve, semen quality, and whether the condition that damaged the first tube may also have affected the second.
How long to try naturally is an individual clinical decision. Age matters, but so do the health of the remaining tube, ovarian reserve, semen quality and how long you have already been trying.[2]
Does the operation affect ovarian reserve?
A common concern before salpingectomy is whether it could affect ovarian reserve. The concern is anatomical: the blood supply to the ovary runs close to the tube.
A review of 21 studies looked at anti-Müllerian hormone (AMH) and antral follicle count after tube removal.[5] Both tests help estimate egg reserve. The results changed with the type of comparison, which helps explain why reports may seem to disagree.
- Comparing the same women before and after surgery: no significant fall in AMH, whether one tube or both were removed. No significant fall in antral follicle count after bilateral removal either.
- Comparing women who had surgery with women who did not: AMH and antral follicle count were lower in the surgery group. The difference in AMH was greater in the bilateral subgroup.[5]
The authors were careful in their conclusion. The results were not final, but they suggested that egg reserve may be lower after tube removal.[5]
These study types answer different questions. Before-and-after studies track change in the same women. Comparisons with a separate control group may also reflect differences that were present before surgery. This includes the disease that led to the operation. The concern is real, but the answer is not settled.
The practical conclusion is to discuss ovarian reserve before surgery, together with the planned technique and available alternatives.
Dr. Aksoy’s Approach
I tell patients that the risk is not zero, but that a large loss of ovarian reserve is not expected.
Studies that compare the same woman before and after surgery do not show a significant fall. The lower values in case-control studies may come from the operation, but they may also reflect what led to it — a hydrosalpinx, an earlier infection, an ectopic pregnancy, endometriosis or a lower starting reserve. I explain that any effect is likely to be small, while being honest that it cannot be ruled out. That caveat matters most when both tubes are being removed or the operation is technically difficult.
By contrast, the evidence that a communicating hydrosalpinx can reduce the chance of clinical pregnancy with IVF is stronger.[1,2] For most patients, the benefit of treating it outweighs the uncertain risk to ovarian reserve.
Where the balance is closer, there are options. If AMH is very low, both tubes are to be removed, or the tube is densely adherent to the ovarian hilum, egg or embryo freezing before surgery may be considered. Proximal tubal occlusion can also be considered instead of removing the tube.
Surgical technique also matters. The mesosalpinx is the tissue that carries blood vessels beside the tube. I divide it close to the tube wall, away from the ovary. I protect the vessels and ligaments that feed the ovary. I use the lowest effective heat in short, precise bursts and avoid repeated cautery near the ovary. Where scar tissue is dense, I prefer careful cutting rather than more heat.
If removing the whole tube would put the ovary’s blood supply at risk, I do not trade reserve for anatomical completeness. The goal is to end the hydrosalpinx’s connection with the uterus while keeping the ovary’s blood supply intact.
These are reasonable points to discuss with your surgeon before consenting. This clinical approach was recorded on 18 August 2026; ASRM also discusses the role of tubal surgery in assisted reproduction.[2]
What to expect afterwards
Salpingectomy is often performed by laparoscopy through small incisions. Recovery depends on the extent of the operation and whether another procedure was carried out at the same time.
Follow your surgical team’s instructions on wound care, pain relief, lifting, driving and returning to work. Contact the team if your recovery is not following the plan they gave you.
Your IVF team will advise when treatment can continue after postoperative review. If hydrosalpinx was the reason for surgery, treatment of the tube is generally completed before embryo transfer.[1,2] If embryos are already frozen, your clinic can plan transfer after surgery and recovery.
At follow-up, ask whether the tube was removed completely or a remnant remains, and what the operation showed about the other tube. Both affect what comes next.
FAQ
Can you get pregnant naturally without fallopian tubes?
No. Natural conception requires a tube to collect the egg and carry the embryo to the uterus. IVF bypasses the tubes entirely and may still be an option.
Can you get pregnant with one fallopian tube?
Natural conception may be possible if the remaining tube is open and healthy. It can sometimes collect an egg released by the opposite ovary, although the available study did not measure the overall chance of conception.[4]
Will removing my tubes lower my egg reserve?
The evidence is mixed. Studies comparing the same women before and after surgery found no significant fall in AMH, while studies comparing women who had surgery with women who had not did find lower levels. It is a reasonable question to raise with your surgeon before the operation.
How long after tube removal can I start IVF?
Your IVF team will decide after reviewing your recovery. If surgery was done because of hydrosalpinx, treatment of the tube is generally completed before embryo transfer.[1,2]
Sources
- Melo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, Becker C, Granne IE. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020;10(10):CD002125. PubMed · doi:10.1002/14651858.CD002125.pub4
- ASRM Practice Committee. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion (2021). ASRM
- Ecochard R, Gougeon A. Side of ovulation and cycle characteristics in normally fertile women. Hum Reprod. 2000;15(4):752–755. PubMed · doi:10.1093/humrep/15.4.752
- Ross JA, Davison AZ, Sana Y, Appiah A, Johns J, Lee CT. Ovum transmigration after salpingectomy for ectopic pregnancy. Hum Reprod. 2013;28(4):937–941. PubMed · doi:10.1093/humrep/det012
- Kobayashi M, Kitahara Y, Hasegawa Y, Tsukui Y, Hiraishi H, Iwase A. Effect of salpingectomy on ovarian reserve: a systematic review and meta-analysis. J Obstet Gynaecol Res. 2022;48(7):1513–1522. PubMed · doi:10.1111/jog.15316
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The content has been created by Dr. Senai Aksoy and medically approved.