BACKGROUND: Although ectopic pregnancies, nonviable missed abortions or blighted ova may occur subsequent to female sterilization, intrauterine pregnancy has not been reported. The sterilization failure risk persists for years after the procedure and varies by operator technique, method of tubal occlusion and female age. CASE: A viable, 8-week intrauterine pregnancy developed in a 36-year-old woman, gravidity 3, parity 2, five years after laparoscopic tubal sterilization. CONCLUSION: The possible mechanisms for a pregnancy after tubal sterilization may be spontaneous reanastomosis or fistula formation or a viable endosalpinx caused by the failure of electrocoagulation. Operator failure may occur when the occluding device is placed on the round ligaments. In this case study, the pregnancy was most likely related to a possible fistula formation which could have developed over the years following surgery. © Journal of Reproductive Medicine®, Inc.