A 26-year-old gravida 3, para 0 female was referred to our hospital at 6 + 5 weeks of gestation due to a suspicion of left tubal ectopic pregnancy. The patient's medical history included one miscarriage and two ectopic pregnancies in the right tube, which had been surgically treated with right partial salpingectomy 4 years ago and right remnant salpingectomy 2 years ago, respectively. During these two ipsilateral salpingectomy procedures, normal left tubal patency was confirmed by chromotubation using indigo carmine. All of the pregnancies were established via natural conception, and during the first ectopic pregnancy the patient was diagnosed with a Chlamydia trachomatis infection. On admission, she was free from abdominal pain and vaginal discharge. Transvaginal ultrasonography revealed the absence of an intrauterine pregnancy and the presence of a left tubal ectopic pregnancy (a fetus and a fetal heartbeat were detected). The patient exhibited a serum beta-human chorionic gonadotropin (hCG) level of 4,000 international units/mL. We fully discussed the surgical options with the patient, whether to perform salpingectomy or salpingotomy, and she selected salpingectomy, even though this would result in the loss of her natural fertility, as she was concerned about the risk of a fourth ectopic pregnancy. Due to the appearance of marked peritoneal irritation, an emergent laparotomy was performed. We found massive hemoperitoneum, and a left tubal isthmus ectopic pregnancy. To prevent any further recurrence, we performed left complete salpingectomy based on the patient's wishes. The clinical diagnosis of tubal ectopic pregnancy was confirmed histologically. The patient's postoperative course was uneventful, and a serum beta-hCG test produced a negative result at one postoperative month. The patient gave birth after in vitro fertilization without any problems.