Hydrosalpinx-the fluid-filled dilation of the fallopian tube secondary to distal tubal occlusion- remains a leading, potentially correctable cause of tubal factor infertility. Its pathophysiology (chronic inflammation, deciliation, fibrosis) and the embryotoxic/mechanical effects of intraluminal fluid substantially impair natural conception and assisted reproductive technology (ART) success. Objective: To synthesize contemporary evidence on the etiology, reproductive impact, diagnostic considerations, and management strategies for hydrosalpinx, with emphasis on fertility-preserving options and optimizing outcomes for women undergoing IVF. Methods: We performed a narrative evidence synthesis prioritizing high-quality sources (systematic reviews, meta-analyses, large cohorts, matched case–control studies, and guideline statements). Databases searched included PubMed, Scopus, and Google Scholar using key terms related to hydrosalpinx, tubal infertility, IVF, salpingectomy, tubal occlusion, and embolization. Studies were appraised for methodological rigor and clinical relevance. Results: Conservative tubal surgery (salpingostomy/neosalpingostomy) yields pooled natural clinical pregnancy rates of ~25–33% in selected patients but carries a recurrence rate (~21%) and ectopic risk (~10%); outcomes are strongly severity dependent (mild disease → high success; severe disease → poor prognosis). Untreated hydrosalpinx reduces IVF implantation and pregnancy rates by ~50%; removal or occlusion of the affected tube before ART reliably improves live-birth rates. Interventional embolization is an emerging minimally invasive alternative with frozen-embryo transfer live-birth rates comparable to hydrosalpinx-free controls. Salpingectomy may increase risk of interstitial implantation in subsequent pregnancies; pediatric hydrosalpinx often has non-infectious etiologies and may resolve conservatively. Population data do not currently demonstrate a clear ovarian cancer-prevention benefit from salpingectomy performed for hydrosalpinx. Conclusions: Management should be individualized and severity-based: conservative repair may be appropriate for fertility-preserving candidates with mild disease, while salpingectomy, proximal occlusion, or embolization is recommended before IVF. Further prospective studies are needed to refine algorithms and evaluate long-term outcomes of minimally invasive approaches.

Hydrosalpinx, tubal factor infertility, salpingostomy

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