Can You Get Pregnant After a Hysterectomy?

Getting pregnant without a uterus isn't possible as a general rule, because after a hysterectomy your uterus (womb) has been removed. The uterus is where the egg implants after fertilization and is the organ that supports and nourishes the growing fetus.

On rare occasions, a fertilized egg can implant outside the uterus, leading to a medical emergency known as an ectopic pregnancy. If not treated appropriately, an ectopic pregnancy can lead to ruptured tissue, internal bleeding, shock, and death.

This article describes why you can't get pregnant without a uterus, and how ectopic pregnancy can occur after a hysterectomy. It explains when a hysterectomy is medically needed. It also presents some of the options available to people who want to start a family but can't get pregnant themselves.

Reasons Why You Can’t Get Pregnant Without a Uterus

The uterus is an organ in the female reproductive system whose primary function is to accommodate the implantation of a fertilized egg (ovum) and support the growth of the fetus until birth. Once implantation occurs, blood vessels develop to deliver uterine milk to the fetus from glands in the lining of the uterus.

These unique features are essential to gestation (the process of development between conception and birth). While implantation of the egg can occur outside of the uterus, no other organ but the uterus can provide the nourishment—and space—for a fetus to develop to term.

A fetus that implants outside of the uterus, as with ectopic pregnancy, is not viable. In the same vein, when a uterus is removed, a person is infertile and cannot get pregnant.

Ectopic Pregnancy

Ectopic pregnancy is the implantation of a fertilized egg outside of the uterus. It can occur after a hysterectomy if the ovaries and fallopian tubes were not removed as part of the procedure. The ovaries are organs that release eggs during ovulation, while the fallopian tubes deliver the eggs from the ovaries to the uterus.

In very rare cases, someone who has had a hysterectomy can experience an ectopic pregnancy if the egg is fertilized after ovulation and implants in a fallopian tube.

An ectopic pregnancy is a medical emergency. It is often not recognized until the growing fetus causes the fallopian tube to stretch and burst. This can lead to internal bleeding, shock, cardiac arrest, and death.

The risk of a rupture is arguably greater in people who have had a hysterectomy as they may assume they cannot get pregnant and misread the signs.

Symptoms

The signs and symptoms of an ectopic pregnancy tend to follow a similar pattern. If the implantation occurs in the fallopian tubes, there may be:

• Vaginal bleeding with pelvic pain, often on one side
• Shoulder pain
• Rectal pain, with an urge to have a bowel movement as the fallopian tube fills
• Abdominal pain, sometimes with diarrhea and vomiting
• Lightheadedness, confusion, and fainting

Clammy or pale skin, with an increasing heart rate, may be signs of shock due to the related blood loss.

Treatment

If an ectopic pregnancy is diagnosed early, the drug methotrexate can be given by injection in a single dose. The drug stops cells from growing, which ends the pregnancy. The fetus is then absorbed by the body over a period of four to six weeks.  

If bleeding has already occurred, surgery is needed to either remove the implanted fetus from the fallopian tube or to remove the fallopian tube with the implanted fetus.

Why Do Some People Need a Hysterectomy?

A hysterectomy is typically pursued when conservative treatments fail to relieve a uterine condition. In some cases, a hysterectomy is the only option.

Indications for a hysterectomy include:

• Cervical cancer
• Chronic pelvic pain
• Endometriosis
• Gender-confirmation surgery
• Heavy, irregular vaginal bleeding
• Uterine cancer
• Uterine fibroids
• Uterine prolapse

Having a Baby After Hysterectomy

If you want to have children but need a hysterectomy for medical reasons, it is still possible for you to start a family.

Egg Harvesting

One option is to undergo egg harvesting if your ovaries were preserved during the hysterectomy. This involves the insertion of a hollow-tipped needle into the vagina, which the provider uses to suction mature eggs out of one or both ovaries.

Surrogate Implantation

The harvested eggs can then be used for surrogate implantation. This is when an egg is fertilized and implanted into the uterus of another person who will carry the baby to term for you.

There are different types of surrogacy, some in which the surrogate has a genetic relationship to the fetus and, more commonly, others in which they do not (called gestational surrogacy). The laws on surrogacy will vary depending on where you live, but it's an option for people who do not have a uterus that can support a pregnancy.

Adoption

Another option is to pursue adoption with an adoption agency. There are many benefits from doing so, and different types of adoption processes, like open adoption in which you may stay in contact with the child's family.

Successful adoption can be a long process with significant costs. Careful research about your options is as important as ensuring that you're ready to begin the adoption process.

Summary

Pregnancy after a hysterectomy is extremely rare but can occur, leading to a potentially life-threatening medical condition called an ectopic pregnancy. This occurs when a fertilized egg implants outside of the uterus.

Once you undergo a hysterectomy, you cannot get pregnant. If you want a baby, you can consider adoption or undergo egg harvesting with surrogate implantation.