Having Children After Hysterectomy: IVF and Surrogacy

ByThe PartialHysterectomy.net Editor

A hysterectomy removes the uterus, so you can no longer carry a pregnancy. That part is final. What it does not always take away is the chance of having a child who is genetically yours. If your ovaries were kept, they usually go on making eggs, and those eggs can be collected through IVF and the embryos carried by another woman, a gestational carrier (surrogate). If your ovaries were removed, donor eggs, donor embryos, adoption and, for a small number of women, a uterus transplant are other routes. This guide to having children after hysterectomy explains each option, what IVF looks like after a hysterectomy, how surrogacy works in the United States and what to ask before surgery if you have not had it yet.

The short answer

  • You cannot get pregnant or carry a baby after a hysterectomy, whether it was a total or a partial (supracervical) one. Pregnancy needs a uterus.
  • If you still have at least one working ovary, you can usually do IVF with your own eggs. The embryos are then transferred to a gestational carrier, who carries the pregnancy for you.[1][2]
  • If you froze eggs or embryos before surgery, they can be used with a gestational carrier later.[13]
  • If your ovaries were removed and nothing was frozen, the options are donor eggs or donor embryos with a gestational carrier, adoption or fostering.[10]
  • Uterus transplant lets a small number of women carry their own pregnancy, but it is offered at only a few centers, and mostly to younger women born without a uterus.[11]

What a hysterectomy changes, and what it doesn’t

The uterus is where an embryo implants and grows. Once it is removed, pregnancy is no longer possible, and that is true even after a partial hysterectomy, where the cervix stays but the body of the uterus is gone. The difference between the types of surgery matters more for your eggs than for pregnancy:

  • Uterus removed, ovaries kept: your ovaries usually keep releasing an egg each month and making hormones until natural menopause. You just no longer have periods, so you cannot see your cycle. These eggs can be collected for IVF.
  • One ovary kept: a single working ovary is usually enough for IVF, although it may produce fewer eggs per cycle.
  • Both ovaries removed: you no longer have eggs of your own, unless some were frozen before surgery. You also go into surgical menopause.
  • Fallopian tubes removed: this does not affect IVF, which bypasses the tubes.

One caution if you are counting on your ovaries: they may stop working somewhat earlier after a hysterectomy. In a US study of women aged 30 to 47, those who had a hysterectomy with their ovaries kept were nearly twice as likely to reach ovarian failure over the following years as women who did not have surgery (14.8% vs 8.0% after four years).[3] It is not clear whether the surgery or the condition behind it is the cause. Either way, if you want to use your own eggs, it is worth seeing a fertility specialist sooner rather than later. More on this in our guide to menopause after hysterectomy with ovaries intact, and on the difference between surgery types in partial vs total hysterectomy.

Gloved doctor pointing to the end of the fallopian tube next to the ovary on a labeled drawing of the female reproductive organs while a smiling patient listens
After a hysterectomy, the uterus is gone but the ovaries may still be there. Whether you kept one or both ovaries is the first thing a fertility specialist will want to know.

Can you get pregnant after a hysterectomy?

Not in the normal way. Without a uterus, an embryo has nowhere to implant and grow. The only exception is extremely rare: an ectopic pregnancy, where an egg is fertilized and implants outside the uterus, usually in a remaining fallopian tube or near the top of the vagina. A 2025 review found only 108 such cases ever published. Many happened around the time of surgery, when a very early pregnancy was already present, but some occurred years later, especially after a partial hysterectomy.[4] An ectopic pregnancy can never continue, and it can be dangerous.

Get urgent medical help if, after a hysterectomy, you have sudden or severe pain low in your belly or on one side, pain in the tip of your shoulder, fainting or dizziness, or a positive pregnancy test.

Your options for having a child

IVF with your own eggs and a gestational carrier

This is the main route for women who kept their ovaries, and the only one that gives you a child who is genetically yours. The steps are the same as standard IVF, except that the embryo goes to another woman’s uterus:

  1. Check of your ovarian reserve. Blood tests (such as AMH) and an ultrasound estimate how many eggs you are likely to produce. Because you have no periods, the clinic times treatment with blood tests and scans instead.
  2. Ovarian stimulation. About 10 to 14 days of hormone injections help several eggs mature at once.
  3. Egg retrieval. Under sedation, a thin needle collects the eggs, guided by ultrasound. In most women this is still done through the vagina, as in any IVF cycle. If your ovaries sit high in the pelvis, are stuck down by scar tissue or were moved out of the pelvis before radiation, the clinic may reach them through the abdomen instead.[5][6]
  4. Fertilization. The eggs are fertilized with your partner’s or a donor’s sperm, and the embryos grow in the lab for a few days. Most are frozen.
  5. Transfer to the gestational carrier. Once the carrier has been screened and legal agreements are in place, an embryo is transferred to her uterus.

Your age when your eggs are collected matters more than anything else: egg numbers and quality fall through your late 30s and 40s. The carrier’s own uterus is usually healthy and proven, which helps. In US data, IVF cycles using a gestational carrier and the intended mother’s own eggs had higher live birth rates than ordinary IVF cycles. They also had more twins and preterm births, a risk that falls when only one embryo is transferred.[7]

Donor eggs or donor embryos with a gestational carrier

If both ovaries were removed, your ovaries no longer work, or your own eggs are unlikely to succeed, donor eggs can be fertilized with your partner’s or a donor’s sperm and the embryo carried by a gestational carrier. Some couples instead use donated embryos left over from another family’s IVF. Donors in the United States go through medical, genetic, infection and psychological screening set out by the American Society for Reproductive Medicine (ASRM).[10] The child will not share your genes, which some women find hard at first. Counseling before starting is part of good practice.

Uterus transplant

The first baby born after a uterus transplant was delivered in Sweden in 2014.[12] In the largest US series, from Dallas, 14 of 20 women had a transplant that worked, and all 14 had at least one baby. But half of those pregnancies had complications, and 11 of the 20 recipients had at least one complication of some kind.[11] The process involves a major operation for the recipient and often for a living donor, IVF, months of anti-rejection medicine, a cesarean birth and a second operation to remove the uterus afterwards. It is done at only a handful of US centers, mostly within research programs, and has mainly been offered to younger women born without a uterus. For most women who have had a hysterectomy, especially for cancer or past their mid-30s, it is not a realistic option today.

Adoption and fostering

Adoption (domestic, international or from foster care) and fostering do not need any further medical treatment. They have their own costs, waiting times and home-study requirements, which vary by state and agency. Many families weigh these alongside surrogacy rather than as a last resort.

How surrogacy works after a hysterectomy

In gestational surrogacy, the carrier has no genetic link to the baby: the embryo comes from your eggs or donor eggs. In traditional surrogacy, the surrogate’s own egg is used, so she is the genetic mother. US medical guidance and most clinics focus on gestational carriers, partly because traditional arrangements raise far more legal and emotional problems.[1][8]

Screening and counseling

ASRM recommendations for clinics that work with gestational carriers cover medical screening of the carrier, infection testing of everyone involved, psychological assessment and counseling for both the carrier and the intended parents, and independent legal counsel for each side before any embryo transfer.[2] Carriers are usually women who have already had at least one uncomplicated pregnancy and birth. Some intended parents work with a relative or friend; others go through an agency that finds and matches carriers.

The legal side

There is no federal surrogacy law in the United States. Each state sets its own rules, from states that clearly allow paid gestational surrogacy and let intended parents be named on the birth certificate before birth, to states that restrict it or leave it unclear.[8] The laws have changed in several states in recent years, so check the current rules where you, the carrier and the clinic are. A written contract and a lawyer experienced in reproductive law for each side are standard, and they also settle questions such as medical decisions during the pregnancy and what happens in difficult situations.

Risks for the carrier and the baby

A gestational carrier takes on the usual risks of pregnancy and birth. In a study of all births in Utah over ten years, serious complications were no more common in carriers than in other pregnancies.[9] The main extra risk comes from transferring more than one embryo, which raises the chance of twins and preterm birth.[7] Many clinics now advise transferring a single embryo.

Costs

Surrogacy is one of the most expensive ways to build a family in the US. The total usually includes IVF and egg retrieval, the carrier’s compensation and expenses, her medical care and insurance, agency fees (if you use an agency), legal fees and counseling. Health insurance rarely covers the carrier’s part, and coverage for your own IVF depends on your plan and your state. Ask clinics and agencies for itemized written estimates. For broader advice on medical costs, see our guide on how to afford a hysterectomy, which also covers insurance appeals.

If you have not had your hysterectomy yet

If there is any chance you will want a child in the future, raise it before surgery. These are the questions worth asking:

  • Do I need a hysterectomy now, or is there a treatment that keeps my uterus? For fibroids, a myomectomy or other alternatives to hysterectomy may be possible. Some women with very early cervical cancer can have a fertility-sparing operation instead.
  • Can my ovaries be kept? If they are healthy and you are not at high inherited risk of ovarian cancer, keeping them preserves your eggs and hormones.
  • Should I freeze eggs or embryos first? This matters most if your ovaries will be removed or damaged by surgery, radiation or chemotherapy. ASCO guidelines say that people with cancer should be offered fertility counseling and a referral to a specialist before treatment starts, and list egg, embryo and ovarian tissue freezing as established options.[13] Egg freezing for other reasons is also an accepted option.[14]
  • Will I have pelvic radiation? If so, ask whether your ovaries can be moved out of the radiation field (ovarian transposition), which ASCO also lists as an established method.[13]
  • How much time do I have? One cycle of egg or embryo freezing takes about two weeks. Ask your surgeon whether that delay is safe for you, and ask for an early referral so it does not hold up your treatment.

If you are still deciding about surgery, our guide to preparing for a hysterectomy includes more questions to take to your appointment.

The emotional side

Losing the ability to carry a pregnancy can bring real grief, even when the surgery was the right decision and even if you had not planned more children. It can come up again during IVF, while watching someone else carry your baby, or when people ask questions. Talking to a counselor who knows fertility treatment and third-party reproduction often helps, and counseling is already built into most surrogacy and donor programs.[2] Support groups for intended parents can also connect you with women who have been through the same thing. For the longer view, see our article on life after hysterectomy.

Frequently asked questions

Can you have a baby after a partial hysterectomy?

Not by carrying the pregnancy yourself. A partial (supracervical) hysterectomy removes the body of the uterus, where a pregnancy grows, and leaves only the cervix. If your ovaries were kept, you can still have a genetic child through IVF and a gestational carrier.

Do my ovaries still release eggs after a hysterectomy?

Yes, if they were not removed. They usually keep ovulating until natural menopause, although that may come a little earlier than it would have.[3] The egg is simply absorbed in the body each month, since there is no uterus for it to reach.

Can eggs be collected through the vagina after a hysterectomy?

Usually, yes. The ovaries are still close to the top of the vagina, so the standard ultrasound-guided needle method normally works. If the ovaries cannot be reached that way, for example after they were moved for radiation, the eggs can be collected through the abdomen.[5][6]

Can I donate my eggs after a hysterectomy?

Possibly, if your ovaries are working. A hysterectomy itself does not rule you out, but egg donors go through medical, genetic and psychological screening, and clinics strongly prefer younger donors. The reason for your hysterectomy also matters: a hereditary cancer risk, for example, may rule out donation.[10] A clinic’s donor program can tell you whether you qualify.

Will the baby be genetically mine?

With your own eggs and a gestational carrier, yes. The carrier has no genetic link to the baby. With donor eggs, the baby is genetically related to the sperm provider but not to you.

Is it too late if my hysterectomy was years ago?

Not necessarily. What matters is your age now and how your ovaries are working, not how long ago the surgery was. A fertility specialist can check this with blood tests and an ultrasound. If your own eggs are no longer likely to work, donor eggs or donor embryos remain possible at any age a clinic will treat.

Sources

  1. American College of Obstetricians and Gynecologists. Committee Opinion No. 660: Family building through gestational surrogacy. Obstetrics & Gynecology. 2016;127(3):e97–e103. pubmed.ncbi.nlm.nih.gov
  2. Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices using gestational carriers: a committee opinion. Fertility and Sterility. 2022;118(1):65–74. pubmed.ncbi.nlm.nih.gov
  3. Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics & Gynecology. 2011;118(6):1271–1279. pmc.ncbi.nlm.nih.gov
  4. Awonuga A, Agboroko S, Moussa D, et al. Ectopic pregnancy after hysterectomy study: a systematic review of published case reports comparing ectopic pregnancy following total and supracervical hysterectomy. Journal of Obstetrics and Gynaecology Research. 2025;51(4):e16268. pubmed.ncbi.nlm.nih.gov
  5. Selvaraj P, Selvaraj K, Gangadharan C, et al. India’s first successful surrogate birth after percutaneous oocyte retrieval following modified radical hysterectomy and right ovarian transposition to the anterior abdominal wall. Journal of Human Reproductive Sciences. 2019;12(3):262–266. pubmed.ncbi.nlm.nih.gov
  6. Ingold C, Navarro PA, de Oliveira R, et al. Feasibility and safety of combined laparoscopic and transvaginal oocyte retrieval in a woman with vaginal recurrence of cervical adenocarcinoma: a case report. Frontiers in Reproductive Health. 2023;5:1295939. pubmed.ncbi.nlm.nih.gov
  7. Perkins KM, Boulet SL, Jamieson DJ, Kissin DM. Trends and outcomes of gestational surrogacy in the United States. Fertility and Sterility. 2016;106(2):435–442. pubmed.ncbi.nlm.nih.gov
  8. Swanson K, Ayala NK, Barnes RB, et al. Understanding gestational surrogacy in the United States: a primer for obstetricians and gynecologists. American Journal of Obstetrics & Gynecology. 2020;222(4):330–337. pubmed.ncbi.nlm.nih.gov
  9. Swanson K, Letourneau JM, Kuppermann M, et al. Obstetric morbidity in gestational carrier pregnancies: a population-based study. Journal of Assisted Reproduction and Genetics. 2021;38(1):177–183. pubmed.ncbi.nlm.nih.gov
  10. Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Gamete and embryo donation guidance. Fertility and Sterility. 2024;122(5):799–813. pubmed.ncbi.nlm.nih.gov
  11. Testa G, McKenna GJ, Wall A, et al. Uterus transplant in women with absolute uterine-factor infertility. JAMA. 2024;332(10):817–824. pubmed.ncbi.nlm.nih.gov
  12. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. The Lancet. 2015;385(9968):607–616. pubmed.ncbi.nlm.nih.gov
  13. Su HI, Lacchetti C, Letourneau J, et al. Fertility preservation in people with cancer: ASCO guideline update. Journal of Clinical Oncology. 2025;43(12):1488–1515. pubmed.ncbi.nlm.nih.gov
  14. Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion. Fertility and Sterility. 2024;121(4):604–612. pubmed.ncbi.nlm.nih.gov

This article is for general information and is not a substitute for medical advice. Fertility options depend on your age, your ovaries and the reason for your surgery, so always discuss your own situation with your gynecologist or a fertility specialist, and contact them or emergency services if you are worried about any symptom.

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