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Hysterectomies are a dramatic time for women and much distress usually follows because of the magnitude of such an operation. Women of reproductive age are no longer able to have children because the environment where the fetus is supposed to develop safely has been removed. Women who are passed menopause realize that such an advanced surgery at that age could be fatal. Although this logic is accurate in theory, unfortunately, medicine is not always what you expect on the surface and just because a woman has her uterus removed, that does not terminate her chances of pregnancy if she is still in reproductive age. 

To understand how this is possible, it is imperative that you have a basic understanding of all components of this phenomenon. The most pressing issue is to define what exact is a hysterectomy. A point of confusion for a lot of patients (even women) is what this surgery actually entails. If a patient requires a hysterectomy, only the uterus will be removed. This is a common operation on its own and can be done for a number of reasons like fibroids, prolonged period bleeding or endometriosis to name just a few. 

If a malignancy is suspected, a hysterectomy may not be enough. Although the uterus does produce a lot of different estrogens, the ovaries are another factory where these can be formed. Doctors will generally play it safe and recommend that patients get a hysterectomy with a bilateral salpingo-oophorectomy. Before I lose you completely, this just means that both fallopian tubes and ovaries are removed along with the uterus to remove all female reproductive organs that could fuel the growth of a tumor. In this case, pregnancy will be impossible afterwards. 

Now that we know that the uterus can be the only thing that is removed in some cases, let's complicate things even further. It is possible to remove only parts of the uterus in the event that a pathology is localized to a small region of the uterus. This is termed a subtotal hysterectomy, or a "partial hysterectomy." In this case, the ovaries are still present, the fallopian tubes have not moved and there is still a cavity for a fetus to develop. Pregnancy is still very much on the table. 

Even though with subtotal hysterectomies still have the capability of bearing children, medically speaking, it is something that is not recommended. After having such an invasive operation to remove even part of the uterus, scar tissue that builds on the walls of the remaining piece of the uterus can make pregnancies very dangerous for the expecting mother. Internal bleeding, uterine rupture and ectopic pregnancies are all medical emergencies that also have very high mortality rates. Of course there are a few cases where women will be able to deliver a baby without serious complications but you would be essentially playing "medical Russian roulette" with two people's lives at stake. Doctors may consider leaving parts of the uterus to help women manage their menstrual cycles and benefit from the estrogens that help prevent osteoporosis. 

If you were reading closely, you may have noticed that there was only one condition where I stated that pregnancies were impossible. That would be with a total hysterectomy with a bilateral salpingo-oophorectomy. To quench your curiosity, that means that it is even possible for women with total hysterectomies to get pregnant. In one interesting medical case, the fetus was able to implant itself onto the wall of the abdominal cavity and was only discovered by accident after the 14th week of pregnancy. Even if it may seem obvious in retrospect, pregnancy is something that even doctors may not consider first when they read that a patient has had a total hysterectomy and bloating, abdominal pain and vaginal bleeding will be most likely worked-up as a malignancy before someone pulls out the ultrasound machine. 

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