Abstract
Background: Infertility affects about 15% of couples. There are several etiologies of infertility, which comprise ovulatory disorders, tubal diseases, and semen abnormalities in males. Hysteroscopy (HS) has been considered as the best approach for uterine assessment, in particular when there is a suspicion of unexplained infertility (UEI). It plays an essential role as regards both taking biopsies and management of pathological conditions in the same diagnostic context.   
Aim: To explore the uterine cavity using of office hysteroscopy (oHS) and take endometrial biopsy to evaluate the endometrial pathology in patients with UEI.
Methods: This study was observational cross-sectional study. This study included fifty-three women with UEI with normal ovulation and they had healthy patent tube as revealed by Hysterosalpingography (HSG). Entire cases were divided into two subgroups; primary and secondary, which represented 49.1% and 50.9% of cases respectively. Histopathological biopsy and findings of HS were documented. 
Results: There was no statistically significant difference detected between cases with normal and abnormal hysteroscopic findings in terms of other complaints, pathological findings and pregnancy rate. There was statistically significant difference is detected between cases with normal and abnormal pathological findings as regard type of infertility. Every increase in one year in age increases the risk of 2ry infertility by 1.14. Urban residence has increased risk of 2ry infertility by 3.33 times than rural residence, abnormal pathological findings increase risk of 2ry infertility by 3.58 times than normal pathological findings. 
Conclusion: Hysteroscopy is considered as a routine step in the fertility work-up program and becomes obligatory before the final diagnosis of UEI. It is an ideal diagnostic approach to several undiagnosed intrauterine pathologies after failure of different routine approaches.