Hydrosalpinx is a disease characterized by dilated, fluid-filled, distally obstructed uterine tubes developed due to acute salpingitis after pelvic inflammatory disease (PID).Its detrimental impact on implantation and pregnancy rates has been well documented. Several studies have been shown hydrosalpinx is associated with decreased endometrial and subendometrial blood flows, higher expression of inflammatory cytokines and chronic salpingitis leading to structural damage of endometrium and impaired endometrial receptivity. Here the effect of hydrosalpinx in the regulation of endometrial receptivity through its influence on endometrial pattern, uterine contractions, and vascularization indices will be described. In addition, structural and ultrastructural changes of endometrium exposed to hydrosalpingial fluid during window of implantation will be discussed.