Background <p>Surgically-induced ampullary hydrosalpinx is a potential complication following salpingostomy for ectopic pregnancy, yet its impact on subsequent IVF/ICSI outcomes remains unclear. This study aimed to investigate the efficacy of surgical correction of this specific hydrosalpinx type.</p> Methods <p>This retrospective cohort study analyzed 374 patients diagnosed with ampullary hydrosalpinx via hysterosalpingography or hysterosalpingo-contrast sonography after previous salpingostomy for tubal ectopic pregnancy. Participants were divided into a surgically treated group (<i>n</i> = 86) and an untreated group (<i>n</i> = 74) for frozen embryo transfer (FET) cycles, with additional fresh transfer cycle data included. Primary outcomes included implantation rate, clinical pregnancy rate, live birth rate, and miscarriage rate.</p> Results <p>In frozen embryo transfer cycles, the surgically treated group was linked to a markedly lower incidence of early miscarriage compared to the untreated group (5.6% vs. 20.0%, <i>P</i> = 0.028), with an adjusted odds ratio of 0.24 (95% CI: 0.06–0.93, <i>P</i> = 0.039). The surgically treated group also exhibited numerically higher rates of clinical pregnancy (62.8% vs. 60.8%) and live birth rates (58.1% vs. 47.3%), though these differences did not reach statistical significance. In fresh embryo transfer cycles, no significant differences in reproductive outcomes were observed between the two groups.</p> Conclusion <p>Surgical management of ampullary hydrosalpinx prior to frozen embryo transfer is associated with a significantly reduced risk of early miscarriage. These findings support considering surgical intervention, particularly salpingectomy, for patients with iatrogenic hydrosalpinx prior to FET to improve reproductive outcomes.</p>