Should You Remove a Normal Fallopian Tube in IVF Patients?
No, you should not remove a normal fallopian tube (without hydrosalpinx or ectopic pregnancy) in a patient using IVF for pregnancy—there is no evidence supporting this practice and it would cause unnecessary harm.
The Evidence for Tube Removal is Specific to Hydrosalpinx
The literature consistently demonstrates that salpingectomy improves IVF outcomes only when hydrosalpinx is present:
- Hydrosalpinx reduces IVF success by approximately 50%, with clinical pregnancy rates dropping from 46% to 22% when hydrosalpinx is left untreated 1
- Salpingectomy for hydrosalpinx significantly improves outcomes, increasing clinical pregnancy rates (46% versus 22%) and birth rates (40% versus 17%) in the first IVF cycle 1
- The mechanism involves embryotoxic hydrosalpingeal fluid that leaks into the uterus, directly damaging embryos and impairing endometrial receptivity 2
Normal Tubes Should Be Preserved
When the fallopian tube is normal (no hydrosalpinx, no ectopic pregnancy history, no pathology):
- There is no mechanical or chemical interference with IVF success since normal tubes do not produce embryotoxic fluid 3, 2
- Removing a normal tube provides no fertility benefit and eliminates any possibility of spontaneous conception
- Surgical risks outweigh any theoretical benefits, including anesthesia complications, adhesion formation, and potential ovarian blood supply compromise
The Only Exception: Cancer Risk Reduction
The guidelines mention salpingectomy in completely different contexts unrelated to IVF optimization:
- Opportunistic salpingectomy during other pelvic surgery (hysterectomy/oophorectomy) for ovarian cancer risk reduction 4
- Prophylactic salpingectomy in BRCA mutation carriers as part of risk-reducing surgery, not for fertility enhancement 4
These recommendations apply to women undergoing surgery for other indications or at high genetic risk—not to fertility patients with normal tubes seeking IVF.
Clinical Algorithm
If hydrosalpinx is present on ultrasound:
- Perform laparoscopic salpingectomy before IVF 3, 1
- Alternative: hydrosalpinx sclerotherapy if surgery is high-risk 5
If tubes are normal:
- Proceed directly to IVF without surgical intervention
- Preserve tubes to maintain spontaneous conception potential
- No benefit from prophylactic removal
Common Pitfall to Avoid
Do not confuse the strong evidence for removing diseased tubes with hydrosalpinx with any indication to remove normal, healthy tubes in IVF patients. The research specifically addresses pathologic hydrosalpinx, not normal tubal anatomy 3, 6, 2.