Background: Hysteroscopy (HS) is a frequently utilized procedure for diagnosing and treating intracavitary pathologies in gynecological practice. It is a favored procedure for assessing of infertile women. While different types of ultrasounds scanning for infertility such as baseline or screening ultrasound, follicular monitoring ultrasounds, saline infusion sonograms (SIS) with or without three-dimensional transvaginal ultrasonography (3D-TVS) evaluation are utilized to evaluate uterine cavity. Abdominal ultrasound might be required with any of the above scanning modalities for better assessment of pelvic structures. Objective: The current study aimed to evaluate the diagnostic accuracy of 3D ultrasonography versus hysteroscopy for assessment of uterine cavity in infertile females. Patients and methods: The diagnostic study included 139 infertile patients. All cases were subjected to detailed history taking with special focus on age, parity, age of menarche, past history of obstetric problems or surgeries. All patients had pelvic 3D TVS assessment and then reassessed by hysteroscopy. Results: The 3D TVS showed perfect performance characteristics for detection of uterine abnormalities in relation to hysteroscopy as a standard method, with sensitivity of 96.9%, specificity of 85.7%, positive predictive value (PPV) of 94%, negative predictive value (NPV) of 92.3%, and accuracy of 93.5%. The 3D TVS showed perfect performance characteristics regarding any Mullerian abnormality, septate uterus, subseptate uterus, bicornuate uterus, unicornuate and arcuate uterus. Conclusion: 3D TVS is a cost-effective, non-invasive modality without complications in comparison with HS, must be considered as a first-line investigation in infertility.