The widespread adoption of IP-based telecommunication core networks is leading to a paradigm shift in international interconnection where the traditional Time-Division Multiplexing (TDM) interconnection between telecommunication networks is being replaced by IP interconnection. IP eXchange (IPX) is an emerging paradigm in international IP interconnection that has novel requirements, such as an end-to-end Quality of Service (QoS) guarantee across multiple carriers. IPX is a future direction for international telecommunications, but it is not easy to understand the overall concept of IPX because it is derived from a wide variety of services, technical knowledge, and telecommunication backgrounds. The confusion and complexity of the technical elements hinder the development of IPX. Thus, this paper clarifies the state-of-the-art technical elements from an IPX perspective and discusses ongoing challenges and emerging services on IPX, particularly end-to-end QoS, Voice over IP issues, IP Multimedia Subsystem (IMS) interworking, and Long Term Evolution (LTE) roaming. This paper also surveys published academic research studies that were not focused primarily on IPX but which are likely to provide potential solutions to the challenges.