Tubal factor infertility is the commonest cause of female infertility in developing countries. The option of management is either tubal surgery or in-vitro fertilisation and embryo transfer (IVF-ET). This study aims to determine the outcome of tubal macrosurgery in Gombe, North-eastern Nigeria. It was a 6-year retrospective review of tubal macrosurgeries performed between January 2001 and December 2006. Of the 92 women who underwent tubal surgery, during the 1-year follow-up, seven (7.6%) became pregnant: five (5.4%) had full-term pregnancies and two (2.2%) had a spontaneous abortion. The majority (64, 69.6%) were aged between 25 and 34 years. The mean age and parity were 29.41 +/- 4.36 and 0.57 +/- 0.80, respectively. Most (48, 52.2%) of the patients presented within 4 years and three (3.3%) presented more than 19 years later. Secondary infertility (58, 63%) was the commonest cause; mild tubal disease occurred in 21 (22.8%) patients. Salpingostomy was performed in 29 (31.5%); salpingolysis in 19 (20.7%) and multiple procedures in 33 (35.9%). The low pregnancy rate seen in this study is unlikely to improve significantly even with good case selection as long as tubal macrosurgery is the modality of treatment. Establishment of affordable in vitro fertilisation (IVF) centres is the key to solving the problem of tubal factor infertility in our environment.