This patient had been married for more than 10 years and had never been pregnant. She came to us because many of the patients around her had successfully conceived after visiting our clinic and undergoing minimally invasive fertility surgery. She wanted to get rid of the pain and also wanted to have a chance to get pregnant again. She had no complicated medical experience, as her family had already adopted a child, and her husband did not support her going back to the doctor. She was not willing to do so, but she had to keep her wish buried in her heart. Now she came to the clinic because of vague pain in her lower abdomen. The vaginal ultrasound showed bilateral hydrosalpinx and the thickest part of the hydrosalpinx was 5-6cm in diameter. Under normal circumstances, the fallopian tubes are a very small tube, and now that they are so large from the fluid, they will definitely pull on the nerves and cause pain. Therefore, whether she still wanted to have children or not, her surgery was inevitable. We agreed before the surgery, and I understood the patient’s mind. If the tubes were found to be really useful intraoperatively, I would try to preserve them and leave a memory for the patient, and this was justified from her husband. The following is the manifestation of hydrosalpinx in this patient: Although I often perform surgery for hydrosalpinx and have seen severe hydrosalpinx, it is rare to see such a thick, stiff tube. When seeing such a tubal, based on the accumulation of previous cases and the consensus of experts in the medical field, this kind of tubal has lost its reproductive function. If one wants to do IVF without dealing with such a tube, the success rate is also very low, and even if one gets pregnant, the chance of miscarriage will be increased. Therefore, the treatment for this patient is to remove the fallopian tubes. Normally, I would put a mirror inside the fluid-filled fallopian tube to see if the mucous membrane is okay before deciding whether to keep the tube or not. However, the condition of the adhesions around the tubes and the degree of tubal stiffness in this patient would not require such a procedure. Even a proximal ligation or embolization of the proximal fallopian tube can leave the potential for chronic lower abdominal pain or worsening tubal pathology in the future. However, not all cases of hydrosalpinx have to be excised or proximal ligation or proximal embolization, because this is a death sentence for the fallopian tubes. I often make the analogy that there are different degrees of hydrocele and different degrees of damage to the fallopian tubes. Just like those who commit crimes, they are not just pulled out and shot as soon as they commit a crime, but only those who commit felonies are deprived of their lives. Which tubal effusion needs to be removed? Because there are many, many fewer doctors who perform minimally invasive assisted conception procedures than those who perform IVF, all we can hear is that the tubes should be removed at the first sign of hydrocele. In fact, as a minimally invasive fertility surgeon, one who is passionate about repairing the fertility function of the fallopian tubes so that patients can conceive naturally, I also advocate removing the tubes for those who have stiff tubes, more adhesions around the tubes, plus blockages in other parts of the tubes, or poor state of the mucosa in the abdomen of the tubes. This is because such a tube will be left behind with consequences. It is also not good for IVF. Some of you may worry that removing the fallopian tubes will lose the blood supply to the ovaries, but in fact, this is also related to the doctor’s experience. In fact, this is also related to the surgeon’s experience. If the removal is done closely to the fallopian tubes, taking care to protect the blood vessels around the tubes and the blood supply to the ovaries on the fallopian tube tract, there will be no loss of ovarian function. Therefore, there is no one-size-fits-all. We need some criteria and experience to decide whether to remove a hydrosalpinx. Weighing the impact on the function of pregnancy and the impact on the health of the body, together with professional experience, we naturally have some judgment. I am Chunxiu Hu, from the Affiliated Hospital of Armed Forces Medical College. This scientific article is my original work, please give credit if you need to reproduce it. My specialties are minimally invasive surgery for gynecological diseases and minimally invasive pregnancy aid surgery for female infertility.