A hydrosalpinx is characterized by swelling of the fallopian tube with fluid accumulation, which affects fertility through tubal dysfunction and impaired embryo implantation due to the retrograde flow of tubal secretion into the uterus. Transvaginal ultrasound is the basis for a noninvasive diagnosis with a high specificity. Several treatment options are available: tubal reconstruction in cases of minor adhesions and tubal dysfunction or assisted reproduction as an alternative; however, to improve the success rates of assisted reproduction a salpingectomy, which is still the therapeutic gold standard, laparoscopic and hysteroscopic proximal tubal occlusion or ultrasound-guided puncture of the hydrosalpinx with or without sclerotherapy should be performed prior to assisted reproduction. Current studies are also investigating assisted reproduction with cryopreservation before surgical treatment. This article provides an overview of current studies, meta-analyses and international guidelines on the treatment of hydrosalpinx and infertility.