Ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF/ET) is not rare, but triplet tubal pregnancy after IVF/ET is very rare. We describe a patient with hydrosalpinx in whom a triplet tubal pregnancy occurred on the same side as the hydrosalpinx. Close hormonal and sonographic monitoring of pregnancies achieved through IVF is recommended to ensure the early diagnosis of EP and to avert complications. A triplet tubal EP was considered highly probable after 3 gestational sacs were observed outside the uterus during sonography performed at 6 weeks' gestation. Therapeutic laparoscopy was then performed because methotrexate treatment failed. Appropriate management strategies are discussed.