Abstract: Hydrosalpinx is one of the causes of repeated embryo implantation failures in assisted reproductive technology. It is generally considered that mechanical washout, reduced endometrial receptivity, and toxic effects of hydrosalpinx on the embryos are the major pathogenic mechanisms underlying the effect of hydrosalpinx upon pregnancy outcomes. In recent years, research progress has been achieved in the pathogenic mechanism of hydrosalpinx affecting pregnancy outcomes. For the selection of treatment strategies of hydrosalpinx, clinicians should choose individualized treatment according to the severity of hydrosalpinx of each patient. This article reviews the research progress on the impact of hydrosalpinx on pregnancy outcomes and the selection of treatment strategies, aiming to improve the pregnancy outcomes of patients with hydrosalpinx.