Symmetric nuclear matter is studied within the conserving, self-consistent T-matrix approximation. This approach involves off-shell propagation of nucleons in the ladder diagrams. The binding energy receives contributions from the background part of the spectral function, away from the quasiparticle peak. The Fermi energy at the saturation point fulfills the Hugenholz-Van Hove relation. In comparison to the Brueckner-Hartree-Fock approach, the binding energy is reduced and the equation of state is stiffer.