Aim: To evaluate the clinical efficacy of office hysteroscopy (OH) in  infertile women with looking normal uterine cavity as detected in by TV/US, before starting primary ICSI cycles. Also to evaluate the value of hysteroscopy (HSC) and new ICSI outcomes in women with RIF, (history at least two previous failed ICSI attempts). 
Study Design: A prospective clinical comparative cohort study.
Setting: Obstetrics and Gynecology Department, Menofia  University and a private assisted reproduction unit in Cairo, Egypt.
Methodology: ICSI after hysteroscopy  was performed in two groups of infertile women. Patients with normal uterine cavity (group I, No. 125 ) and patients with RIF ( group II, No. 125). Then, ICSI was performed for all enrolled women in study groups with no statistically significant difference (p > 0.05) regarding demographic data ( except age) and the number of oocytes retrieved and the number of embryo transfer. Then, all subjects were followed up for 3 weeks after embryo transfer for detection of pregnancy by ultrasound.
Result: There was no statistically significant difference in IR both groups (15.8%  Vs. 10.2%). Also, the PR showed no statistically significant difference (32% vs. 22.4%). There was a statistically significant association between PR and hysteroscopy before ICSI in  group II. Also, hysteroscopy had detected uterine cavity lesions in more than half of cases with normal TV/US.
Conclusions: In this study routine office hysteroscopy (OH) was not  an added cost before ICSI even in cases with normal TV/US. OH can diagnose and treat uterine cavity lesions on the same setting. Robust and high-quality multicentric RCTs are advised before hysteroscopy can be included during the basic clinical infertility investigation.