Several retrospective studies have shown an impaired outcome of IVF in the presence of hydrosalpinx. The retrospective data have been compiled and presented in meta-analyses, demonstrating a reduction by half in the probability of achieving a pregnancy in the presence of hydrosalpinx and a doubled rate of spontaneous abortion. The main theories trying to explain the underlying mechanisms have focused on potential embryotoxic properties of the fluid or impaired endometrial receptivity to implantation. Several mouse studies have suggested an embryotoxic effect of the hydrosalpingeal fluid, a finding which is not supported in studies on human embryos. It is believed that the fluid exerts a detrimental effect on the endometrium by altering the receptivity or simply by causing a mechanical hindrance for implantation. Different treatment options would then be tubal ligation, salpingostomy, aspiration of hydrosalpinx fluid or salpingectomy. The effect of aspiration has been studied in a few retrospective trials with contradictory results. Treatment with salpingectomy has entered into clinical practice without proper evidence for its benefit. Concerns have also been raised about the potential hazard of surgical intervention to ovarian circulation and function. A randomized controlled trial on salpingectomy prior to IVF has now been conducted as a multicentre study in Scandinavia. Laparoscopic salpingectomy prior to IVF was shown to be beneficial in patients with large hydrosalpinges that were visible on ultrasound, a result which supports the theory of the fluid being involved in the impaired implantation process.