Objective <p>This study aimed to evaluate the impact of different treatment modalities—expectant management, methotrexate (MTX), and laparoscopic salpingectomy—on the future fertility of women treated for tubal ectopic pregnancies (EP). The primary outcome was to evaluate the mean time to conception, and the secondary outcome was to evaluate live birth rates and the risk of recurrent ectopic pregnancy (REP) between treatment groups.</p> Methods <p>A retrospective analysis was conducted involving 121 women treated for tubal EP from January 2020 to November 2024. The study analyzed fertility outcomes based on the treatment modality received, which included expectant management, MTX, and laparoscopic salpingectomy. Data were collected through hospital records.</p> Results <p>The time to clinical pregnancy was 255 (60–390) days in the expectant group, 270 (60-1080) days in the MTX group, and 255 (90-1440) days in the laparoscopic salpingectomy group. Median time to achieve pregnancy was 270 (95% CI: 222–318) days for all the treatment groups. No significant differences were found in the time to pregnancy across the treatment groups (<i>p</i> = 0.274). Out of 121 patients, 58 (47.9%) achieved pregnancy, of which 33 (27.2%) resulted in live births. Live birth rates were 75%, 58.3%, and 50% in the expectant management, MTX, and laparoscopic salpingectomy groups, respectively. Live birth rates also did not differ between the three treatment groups (<i>p</i> = 0.437). All the three treatment modalities did not show a statistically significant impact on the rates of REP (<i>p</i> = 0.42).</p> Conclusion <p>We found no significant differences in time-to-pregnancy or live birth rates among expectant, MTX, and laparoscopic salpingectomy management for tubal EP. Given EP’s significant impact on fertility in reproductive-aged women, studies comparing treatment effects on future fertility are clinically valuable.</p>