Background: Hysteroscopy is considered the gold standard for the diagnosis of small uterine abnormalities undetected by previous procedures like hysterosalpingography (HSG), as well as uterine abnormalities such adenomyosis, myoma, and polyps. Evaluation of hysteroscopy's use in the diagnosis of female infertility without apparent cause was our aim.

Methods: This prospective cross-sectional study included sixty individuals with unexplained infertility. It was carried out at the Zagazig University Hospital's, Endoscopic Unit in the Department of Obstetrics and Gynecology from October 2023 to May 2024, all patients were subjected to office hysteroscopy.

Results: 28.3% of the 60 women who were the subject of the study reported abnormal hysteroscope results in their uteri. Of the patients, 40% had secondary infertility and 60% had primary infertility. 15% had intrauterine polyps found, which hysterosalpingography and ultrasonography failed to detect. It was shown that 8.3% had uterine niches. There were only one (1.7%) woman with a tiny uterine septum and 3.3% of women with submucous fibroids (grades 0 to 2).

Conclusion: When hysteroscopy is performed, uterine pathology is found in a considerable number of infertile women for unknown reasons. Because office hysteroscopy allows for simultaneous operational correction, patient tolerance, and safety, it is the gold standard for the diagnosis and treatment of intrauterine disease.