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Appropriate management of hydrosalpinges is an important key in improving in vitro fertilization (IVF) success rates. The place of reconstructive surgery is debated as IVF success rates, possibly combined with complementary surgery in case of hydrosalpinges, continue to improve. Salpingostomy by a laparoscopic or laparotomy approach, aims to create a new ostium of the fallopian tube with well-everted fimbrial mucosa, in the case of distal tubal occlusion. Hydrosalpinx fluid can be aspirated under transvaginal ultrasound guidance at any stage in the IVF process, including the stage of oocyte retrieval. The patient burden, surgical risks, and drawbacks of each specific treatment necessitate the best available evidence for a two-step approach in the management of tubal factor infertility. A Cochrane systematic review of randomized controlled trials (RCTs) was updated in 2009 to assess and compare the value of surgical treatments for tubal disease prior to IVF.