Recurrent first trimesteric abortion can occur due to a set of factors such as: genetic, endocrine and immune diseases, coagulation system disorders or anatomical factors. Diagnostic hysteroscopy allows the diagnosis of acquired anomalies, in addition to congenital anomalies. Recently, a reduction in hysteroscopy cost associated with reduced optical diameters has allowed hysteroscopy to be performed in an outpatient basis, with no anesthetics use, minimal discomfort and optimal acceptance by patients. However, hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. This comparative study was carried out to assess the uterine anatomical abnormalities found by office hysteroscopy and hysterosalpingography in 50 patients with recurrent first trimesteric abortion attending the Gynecology Outpatient Clinic of Cairo University Hospitals during the period between October 2013 and February 2014. The positive findings detected by office hysteroscopy represented only 15(30%) of our patients. They were one case of arcuate uterus, 2 cases of septate uterus, 4 cases of myoma, 6 cases of endometrial polyps and 2 cases of intrauterine synechia. The positive findings detected by hysterosalpingography represented only 8 (16%) of our patients. They were one case of arcuate uterus, 2 cases of septate uterus, 3 cases of myoma, one case of endometrial polyp and one case of intrauterine synechia. When comparing the results of HSG with that of the OHS, we found that out of the 15 cases that were diagnosed by OHS as uterine abnormalities, only 8 were confirmed by HSG. We conclude that HSG shows high accuracy in the diagnosis of mullerian anomalies as arcuate uterus and septate uterus, but low accuracy in the diagnosis acquired anomalies as myomas, endometrial polypi and intrauterine synechia. On the other hand, office hysteroscopy allows the diagnosis of acquired anomalies, in addition to congenital anomalies. Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.