Abstract / Summary
Background and Objectives: Hydrosalpinx is an important and treatable cause of impaired in vitro fertilization (IVF) outcomes, but the optimal intervention and its timing remain uncertain. This narrative review evaluates contemporary evidence to support individualized management before IVF. Materials and Methods: Targeted searches of PubMed/MEDLINE records and publisher websites prioritized systematic reviews, meta-analyses, randomized trials, cohort studies, and international guidelines published from January 2015 to September 2026, while retaining earlier landmark studies. Evidence concerning salpingectomy, laparoscopic proximal tubal occlusion (PTO), aspiration, sclerotherapy, ovarian reserve, and treatment timing was synthesized narratively. Results: Clinically significant communicating hydrosalpinx should generally be treated before embryo transfer. Salpingectomy remains the most established definitive intervention, whereas laparoscopic PTO appears to provide comparable clinical pregnancy outcomes and may reduce tubo-ovarian vascular disruption in selected patients. Evidence regarding ovarian reserve after salpingectomy is conflicting: total oocyte yield is often preserved, although some studies report lower anti-Müllerian hormone, antral follicle count, or ipsilateral follicular recruitment. Aspiration and sclerotherapy may be considered when standard surgery is not feasible, but recurrence and limited randomized evidence restrict routine use. Observational studies do not establish a universally superior sequence of surgery and oocyte retrieval. Conclusions: Management should move from a uniform procedure-centered approach toward patient-centered selection. Reproductive age, ovarian reserve, laterality, pelvic adhesions, surgical complexity, and treatment urgency should guide both the intervention and its timing, while effective hydrosalpinx treatment should precede embryo transfer.