Background: There is ongoing debate on the appropriateness of regular hysteroscopy (HSC) in patients having diagnostic laparoscopy as part of an infertility evaluation.A rising body of research is addressing the use of hysterosalpingography (HSG) as a crucial tool for the assessment and treatment of infertile couples, despite the fact that most clinics still utilize HSG as their standard test to evaluate the uterine cavity. Thus, our goal was to assess the diagnostic hysteroscopy's function in infertile women with normal HSG.

Methods: A cross sectional study was conducted at the Department of Obstetrics and Gynecology, at Zagazig university Hospitals in the period from December 2023 till May 2024 including 90 women having infertility. Diagnostic Hysteroscopy Was done for all cases.

Results: Majority of cases had primary infertility (78.9%) and among the studied cases cervical stenosis and endometrial polyp were the most frequent abnormalities (5.6% for each), followed by Intrauterine adhesions, then Submucous myoma, then Chronic endometritis and Cervical Polyp (4.4%, 3.3%, 2.2%, 1.1% and 1.1% respectively. There was no significant difference between the cases who detected abnormality and who didn't as regard Age, period of infertility,BMI, and Type of infertility.

Conclusion: We believe that the use of diagnostic hysteroscopy in the primary routine assessment of infertile women is justified because the incidence of uterine diseases (both congenital and acquired) in women with primary or secondary infertility is approximately 23.3%. When the hysterosalpingeogram is normal, the diagnostic hysteroscopy is equally important in evaluating individuals with primary and secondary infertility.