Infertility may be caused by uterine lesions, such as fibroids, endometrial polyps, intrauterine adhesions, or all of these. Natural conception may also be delayed by congenital uterine abnormalities. One out of every six couples will experience infertility at some point in their lives. Hysterosalpingography (HSG) is the first line of defence in detecting uterine and Fallopian tube anomalies. One of the most often used diagnostic tools in gynaecology is two-dimensional transvaginal sonography (2D-TVS). 2D-SIS has been shown to be an excellent diagnostic tool for intrauterine abnormalities since it may delinate the uterine cavity, allowing any uterine lesion to be clearly depicted. A novel imaging technique, three-dimensional transvaginal sonography (3D-TVS), is already being used in clinical settings. Diagnosis of uterine cavity anomalies requires diagnostic hysteroscopy (DHS). SMFs, endometrial polyps, and IUAs may all be seen clearly in the uterine cavity because to its ability to provide a direct view of the uterine chamber. Three-dimensional transvaginal ultrasound, 2D-SIS, and DHS were compared in this research to see which had the best sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for aberrant uterine findings during HSG (DA). Until recently, diagnostic hysteroscopy (DHS) was the gold standard against which all other types of scanning were measured and evaluated. A cross-sectional study of 200 women attending the Outpatient Clinic of Benha University Hospital with suspected intrauterine abnormalities based on the history, clinical examination, and results of HSG was conducted from July 2018 to July 2021 to evaluate the diagnostic accuracy of 2D- (SIS) and 3D ultrasound in the evaluation of uterine cavity. We found 72 cases of congenital uterine anomalies (5 septum, 4 cervicofundal septum, 1 bicornuate, 4 bicornuate versus septate, 2 unicornus, 2 acute uterus) and 104 cases of intrauterine filling defects (44 polyps, 56 fibroids, and 4 irregular filling defects) in this study of HSG. We also found 24 cases of intrauterine adhesions (20 fine adhesions and 4 coarse adhesions). A total of 164 (82 percent) of the 200 patients examined had abnormalities detected by DHS (the gold standard), while only 36 cases (18 percent) were found to be free of pathological lesions or abnormalities. These findings included 60 cases of congenital uterine anomalies, 80 cases of intrauterine filling defects, and 6 cases of intrauterine adhesions. SMF, endometrial polypi, and both US and DHS are complimentary in the identification of individuals with congenital uterine abnormalities.