Usually an egg has to travel from the ovaries into the fallopian tube to get fertilized, before continuing down to the uterus. Without the tubes it should be nearly impossible to get pregnant, unless the woman uses in-vitro fertilization, which Kough says she didn’t do.

A 2007 article published in the Singapore Medical Journal theorized that in some women who have both tubes removed — a surgery called bilateral salpingectomy — the area where the fallopian tube previously connected to the uterus may not completely close over. In very rare cases, an egg might travel through the space between the ovary and the uterus (“transperitoneal migration”) and reach that opening just at the right moment.

It happens. But not very often. A bilateral salpingectomy is one of the most effective forms of birth control there is.

“When I had the procedure done they were like, ‘It’s about as close to 100% as you can get,’’” Kough said.

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