The presence of a hydrosalpinx has been shown to impair the outcome of in vitro fertilization (IVF) treatment. This outcome can be improved by removing the hydrosalpinx; however, there are some concerns regarding its feasibility and safety, especially in women with previous surgeries and dense adhesions. The purpose of our meta-analysis was to evaluate the efficacy of hydrosalpinx aspiration with or without sclerotherapy on the risk of recurrence and the IVF outcome compared with salpingectomy or no intervention. We performed an electronic-based search using PubMed, Embase, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Our main outcome measures were the recurrence rate, fertility outcome, and adverse events. Ten studies were included in our review. The overall recurrence rates of hydrosalpinx aspiration with or without sclerotherapy were 21.7% to 30.5% and 21.8% to 32.5%, respectively. There was no difference in the clinical pregnancy or miscarriage rate between hydrosalpinx sclerotherapy and salpingectomy. When compared with salpingectomy, hydrosalpinx aspiration only was associated with a significantly lower clinical pregnancy rate and higher miscarriage rate. Compared with no intervention, hydrosalpinx aspiration resulted in significantly higher clinical pregnancies rates but a similar miscarriage rate. We conclude that hydrosalpinx sclerotherapy before IVF improves the fertility outcome and can be used as an alternative to salpingectomy.