Background: The two diagnostic modalities namely office hysteroscopy and transvaginal sonography (TVS) have an important role in diagnosing congenital and acquired uterine abnormalities which may lead to recurrent pregnancy loss (RPL) either in the first trimester or in the second one. Aim of the work: To assess the incidence of anatomic uterine abnormalities detected by office hysteroscopy in comparison to TVS in patients with a history of 2 or more first trimester or second trimester pregnancy loss, and to compare the incidence of anatomic uterine abnormalities between patients with first and second trimester RPL. Patients and methods: This cross-sectional study included 70 patients who were divided into two equal groups; the first one included women with first trimester RPL, and the second one included those with second trimester RPL. Each patient was subjected to 2D TVS followed by office hysteroscopy. Results: The prevalence of anatomic uterine defects in the study groups as diagnosed by office hysteroscopy with complementary diagnostic laparoscopy was 31.42% in the first trimester RPL group, and 11.42% in the second trimester RPL group (p: 0.078). 2D TVS was both sensitive (100%) and specific (93.94%) in diagnosing uterine polyps and submucus fibroids both in first trimester and second trimester RPL groups with office hysteroscopy taken as a reference. However, 2D TVS had a moderate sensitivity (80%) in the diagnosis of a double cavity uterus in the first trimester RPL group, and a low sensitivity (50%) in the diagnosis of the same condition in the second trimester RPL group. Conclusion: The intrauterine causes of RPL in the 1st and 2nd trimesters could be suspected and diagnosed be 2D TVS followed by office hysteroscopy.