Pregnancy After Fallopian Tube Removal: What IVF Can and Cannot Do
Key Takeaways
With one tube left, natural pregnancy can still happen if that side is open. When both tubes are gone, pregnancy needs IVF, which skips the tubes. Taking out a fluid-filled tube before IVF likely raises clinical pregnancy rates. Removed tubes never grow back, and study findings on egg supply remain mixed.
Key evidence: Cochrane review on tubal surgery before IVF (2020) Kobayashi et al. meta-analysis on ovarian reserve after salpingectomy (2022)
Why a tube gets removed
Tubal problems cause about 20% of infertility cases.[1] Surgeons take out a tube when it is badly scarred or swollen with fluid. Surgery may also treat an ectopic pregnancy (one growing outside the womb, most often in a tube). At times, a tube is taken out during another pelvic surgery or for permanent birth control.
In fertility clinics, a frequent cause is a hydrosalpinx, a blocked tube filled with fluid. Leaving it untreated roughly halves IVF pregnancy chances, especially when fluid shows on scan (ASRM guidance, 2021).[1,2]
Our guides to blocked fallopian tubes and the hysterosalpingogram (HSG) explain how tubes are checked before surgery.
Can you get pregnant without fallopian tubes?
When both tubes are gone, pregnancy requires IVF rather than natural conception.
In natural conception, a tube catches the egg after it leaves the ovary. Sperm and egg meet inside that tube, which then carries the early embryo to the womb. Once both tubes are gone, sperm and egg have no route to meet inside the body.
IVF skips the tubes at every step. Doctors collect eggs straight from the ovaries and fertilise them in the lab. A doctor then places an embryo into the womb through the neck of the womb. Because your ovaries and womb stay in place, the whole IVF route stays open. Even so, clinics do an early scan to check the pregnancy sits safely inside the womb.
Does removing the tube improve IVF chances?
Taking out a fluid-filled tube before IVF likely raises clinical pregnancy rates (pregnancies seen on scan).[1] Still, live birth was not reported for that comparison.[1] Closing the tube where it joins the womb — proximal tubal occlusion — can also help when full removal looks risky.[1,2]
Evidence box: Cochrane trial results before IVF
A Cochrane systematic review (a structured research summary) pooled 11 randomised trials in 1,386 women before IVF or ICSI.[1] Randomised trials put patients into groups by chance.
- Tube removal versus no surgery: Four trials in 455 women gave moderate-quality proof. Clinical pregnancy rose, with a risk ratio of 2.02. The 95% confidence interval (the likely true range) ran from 1.44 to 2.82. From a 19% rate without surgery, tube removal brings the rate to roughly 27% to 52%.[1]
- Closing the tube versus no surgery: Two trials in 209 women gave low-quality proof. Proximal occlusion raised clinical pregnancy, with a risk ratio of 3.21 (95% confidence interval 1.72 to 5.99).[1]
- Removal versus closing the tube: Direct trials were too small to show one method beats the other.[1]
No trial in that review tracked live birth (a baby born alive) for tube removal versus no surgery. Seeing a pregnancy on scan matters, yet taking home a baby is the real goal. None of those trials tracked long-term results either. Thus, the trials point to higher scan pregnancy rates, not to proven live births.[1]
Do fallopian tubes grow back?
No. Once taken out, a tube never grows back. Stories of tubes reopening come from mixing up two separate operations:
| Operation | What happens to the tube | Can it reopen? |
|---|---|---|
| Salpingectomy (tube removal) | The tube is taken out | No — nothing is left to rejoin |
| Tubal ligation (tying the tubes) | The tube is cut, tied or clipped in place | Surgical repair is sometimes possible (ASRM, 2021).[2] |
If someone says a tube can reopen, check your surgical note first to see whether your tube was taken out or only tied.
Sometimes a scan or note mentions a tubal stump or remnant. Ask your surgeon how much tube stayed behind, mainly after surgery for an ectopic pregnancy.
Pregnancy with one tube
Having one healthy tube left is very different from having none.
Natural pregnancy can happen if your remaining tube is open and healthy. Your ovaries do not take strict left-then-right turns each month (study of 199 natural cycles).[3]
Even when the ovary on the tubeless side releases an egg, the other tube can sometimes pick it up. In 842 pregnancies after one-sided tube removal for an ectopic pregnancy, about one in three came from the ovary opposite the remaining tube.[4] That study only included women who conceived, so it could not measure overall pregnancy odds.
Your chances rest mostly on whether the remaining tube works well. Doctors also weigh your age, egg supply, sperm test results, and how long you have tried.[2] Past infection or endometriosis may have harmed the other tube too. Because a pregnancy can implant outside the womb, book an early scan as soon as a pregnancy test turns positive, especially after an earlier ectopic pregnancy.
Does the operation affect ovarian reserve?
The evidence is mixed. Studies that follow the same woman before and after surgery show no clear fall in egg supply. Studies that compare operated women with unoperated controls show lower values.
Many women worry that losing a tube will hurt their egg supply. Anatomically, that worry makes sense. Blood vessels for the ovary run right beside the tube. They enter at the ovarian hilum (the point where vessels enter the ovary).
A meta-analysis of 21 studies (a combined count of past studies) checked egg-supply tests after tube removal.[5] It looked at AMH (anti-Müllerian hormone) and follicle counts on scan.
Evidence box: before-and-after versus control-group studies
In Kobayashi et al., 2022, 21 studies entered the review and 16 entered the pooled count:[5]
- Same women before and after surgery: AMH showed no clear drop after taking out one tube or both. In study terms, there was no statistically significant fall (meaning chance could explain the tiny shift). Follicle counts on scan after removing both tubes did not drop clearly either.[5]
- Operated women versus a control group: A control group means unoperated women used for comparison. Operated women had lower AMH (pooled mean difference −0.31 ng/mL overall and −0.71 ng/mL after removing both tubes). They also had fewer follicles on scan.[5]
Before-and-after studies track change in the same woman. Control-group studies can also pick up older gaps, like the disease that harmed the tube.
The review’s authors call their findings not conclusive. Still, they conclude that women who had a tube removed appear to have a lower egg supply.[5] Your starting egg supply, careful surgical technique and the alternatives all belong in your pre-surgery talk.
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
Most tube removals use keyhole (laparoscopic) surgery through small cuts, often as day cases. Mild tummy ache, a few days of tiredness, and shoulder-tip pain from laparoscopy gas are common and pass quickly. Healing takes longer if endometriosis or thick scar tissue was treated too.
Follow your team’s advice on wound care, pain relief, lifting, driving, and work. Get urgent medical help for a fever, worsening belly pain, heavy vaginal bleeding, wound redness or discharge, dizziness, or short breath.
When surgery treats a hydrosalpinx, doctors deal with the tube before embryo transfer (Cochrane review, 2020).[1,2] If embryos are already frozen, clinics can plan a frozen embryo transfer once you have healed.
At your check-up, ask if the whole tube was taken out or if a stump remains. Ask how the other tube looked, too. Those two details tell you whether natural pregnancy is an option and how early to scan next time.
Frequently Asked Questions for Dr. Aksoy
How soon after fallopian tube removal (salpingectomy) do you allow intercourse, trying to conceive naturally, or an embryo transfer?
The answer depends first on why the tube was removed and how the operation went. After a straightforward laparoscopic operation, intercourse can usually resume within 1–2 weeks, once pain and bleeding have settled and healing is adequate. If dense adhesions were released during surgery, endometriosis surgery was carried out at the same time, or a complication occurred, a longer wait may be needed.
Before trying to conceive naturally, I also want the operation to have healed. When surgery was done for an ectopic pregnancy, it is sensible to make sure the pregnancy hormone has returned to normal and, in most cases, to wait one or two menstrual cycles. If methotrexate was used, the waiting period is different again.
In IVF, particularly after salpingectomy for a hydrosalpinx, we can usually plan embryo transfer after the first period — around 4–6 weeks after surgery — if recovery has been straightforward. There is no rule requiring every patient to wait for months.
What decides it for me is less the calendar than the extent of the operation, how well the patient has recovered, and whether she is ready for pregnancy.
How long do you consider it appropriate to try naturally with one tube removed? When do you move to IVF?
Having one tube removed does not mean a woman cannot conceive naturally. Natural pregnancy is possible if the other tube is healthy and open, ovulation is taking place, and sperm parameters are suitable. The remaining tube can even sometimes pick up an egg released from the opposite ovary (Ross et al., 2013).
What I look at most closely here is the woman’s age, the condition of the remaining tube, her ovarian reserve, and how long the couple have been trying for a pregnancy. To a 30-year-old patient whose other tube is healthy and who has no other fertility problem, for example, I may give 6–12 months to try naturally. In a woman aged 38–40, waiting the same length of time may not be the right choice.
If the remaining tube is also damaged, blocked, or affected by a hydrosalpinx, if sperm parameters are markedly impaired, or if pregnancy has not occurred over a long time, I discuss going straight to IVF. For patients who have had an ectopic pregnancy before, I also remind them that an early ultrasound scan is important once they conceive again.
What matters to me is not simply having one tube left, but whether that tube is genuinely working and how much time we have for a natural pregnancy.
Do ovulation and periods continue after one or both tubes are removed? Do eggs build up inside?
Patients sometimes ask me: “Doctor, if my tubes have been removed, where will my eggs go?” In fact, the organs responsible for ovulation are the ovaries, not the tubes. Removing the tubes alone does not normally stop ovulation or menstrual periods as long as the ovaries have been preserved.
At ovulation, the egg cell is still released from the ovary. If it is not picked up by a tube, it loses viability within a short time and is broken down and absorbed naturally by the body. So eggs do not build up inside the abdomen or form cysts.
Women who have had one tube removed can conceive naturally. In women who have had both tubes removed, a natural pregnancy is not expected, though pregnancy through IVF is possible if the ovaries and uterus are healthy.
I explain to my patients that the tubes are not the organs that keep the ovaries working. Removing both tubes does not by itself mean menopause either; the ovaries can continue to produce hormones and ovulate.
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
- Practice Committee of the American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril. 2021;115(5):1143–1150. PubMed · ASRM · doi:10.1016/j.fertnstert.2021.01.051
- 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.