This chapter includes clinical cases, background, evidence‐based practical management options, preventive measures and key‐point summaries of hydrosalpinx and contraindication to laparoscopy. The presence of a hydrosalpinx during an in‐vitro fertilization (IVF) cycle is associated with a significant reduction in pregnancy and implantation rates. Several studies have demonstrated that laparoscopic salpingectomy or tubal occlusion prior to IVF significantly improves implantation, ongoing pregnancy and live birth rates. A randomized clinical trial comparing hysteroscopic proximal tubal occlusion using Essure with laparoscopic salpingectomy as a treatment of hydrosalpinges prior to IVF concluded that hysteroscopic proximal tubal occlusion with the Essure microinsert is inferior to laparoscopic salpingectomy with respect to ongoing pregnancy rates. In 2008, a pilot study was reported on the use of hysteroscopic electrocoagulation of the tubal ostia for potential tubal occlusion in 10 patients with hydrosalpinx prior to IVF. Potential complications of ultrasound‐guided sclerotherapy include ethanol leakage into the abdominal cavity, abdominal pain, pelvic adhesions and infection.