Background: The indication for routine hysteroscopy (HSC) in patients undergoing diagnostic hysteroscopy as part of an infertility work up is still a matter of controversy. Although most clinics continue to use hysterosalpingography (HSG) as their routine test to assess the uterine cavity, there is a growing body of literature dealing with the use of HSC as an important instrument to use in the evaluation and treatment of infertile couples. Objective: To evaluate the role of the diagnostic hysteroscopy in infertile women with normal HSG. Patients and Methods: This cohort observational study was carried out at Ahmed Maher Teaching Hospital, Egypt, from November 2019 till May 2020, on one hundred women Patients having primary infertility. Results: The mean age of the studied cases was 29.58 ± 6.75 with range (20-40). The mean period of infertility was 4.89 ± 1.07 with range (3-7), the mean BMI was 28.27 ± 2.13 with range (25-32). There were 10% illiterate, 45% with moderate education and 45% with high education, there were 92% Primigravida and 8% multigravida, and there were 92% with primary type of infertility, and 8% with secondary type of infertility. There were 17% with diabetes, 28% with hypertension and 13% with previous pelvic surgery. Among the studied cases, there were 38 with detected abnormality, i.e. (5%) endometrial polyp, (2%) Cervical Polyp, (6%) cervical stenosis, (3%) chronic endometritis, (3%) hypertrophic endometrium, (2%) atrophic endometrium, (5%) Intrauterine adhesions, (4%) Cornual fibrosis, (2%) cornual inflammation, (4%) Sub mucous myoma and (2%) septum. There was no significant difference between the cases who detected abnormality and who didn't as regard age, period of infertility, BMI, education, parity and type of infertility. There was no significant difference between the cases who detected abnormality and who didn't as regard menstrual history. There was no significant difference between the cases who detected abnormality and who didn't as regard diabetes, hypertension and previous pelvic surgery. Conclusion: The incidence of uterine pathologies (congenital and acquired) in women with primary or secondary infertility approximated 30%, thus, justifying, the use of diagnostic hysteroscopy in the primary routine investigation of infertile women.