Background: Hydrosalpinx remains a major cause of female infertility, with Palmer-type neosalpingostomy representing a fertility-preserving alternative to salpingectomy in selected patients. While disease severity is a well-established prognostic factor, the contribution of endocrine and infectious comorbidities to reproductive outcomes after tubal reconstruction remains poorly characterized. Patients, Materials and Methods: This retrospective cohort study included 160 women with hydrosalpinx who underwent Palmer-type neosalpingostomy between January 2018 and December 2024 at Independenţa VitaPlus Hospital, Craiova, Romania. Endocrine and infectious comorbidities were systematically assessed preoperatively, including polycystic ovary syndrome (PCOS), thyroid dysfunction, obesity, diabetes, pelvic inflammatory disease (PID), and urinary tract infections (UTI). Pregnancy outcomes were evaluated over a 24-month follow-up period. Statistical analysis included Kaplan–Meier survival estimates and multivariate logistic regression to identify independent predictors of clinical pregnancy. Results: PCOS (30.6%), PID (28.2%), and UTI (18.1%) were the most common comorbidities. Hydrosalpinx se
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