Abstract This study aims to estimate the safety, efficacy, and patient acceptability of adding vaginoscopic office hysteros-copy (VOH) to the routine infertility diagnostic work-up for evaluation of the endometrial cavity. This study is a prospec-tive comparative diagnostic trial. This study was conducted in a tertiary care referral facility and university hospital. This study comprised a total of 156 infertile patients scheduled for laparoscopy. Seventy-eight patients had VOH on one stop bases in addition to the usual infertility work-up and were assigned as group Bwhile a similar number was examined by the usual diagnostic work-up and assigned as group A. The main outcome measure is the diagnostic accuracy of VOH alone in comparison to hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and assessment of combined VOH and HSG in diagnosing intrauterine abnormalities. There was insignificant difference between both groups re-garding socio-demographic and HSG data. Abnormal DL findings were more significant in group A. VOH detected 50 % abnormal endometrial cavity in group B with a signif-icant superiority over HSG. There was a high percentage of agreement in the diagnosis of uterine abnormalities between HSG and VOH (96 %). Generally, VOH was an acceptable procedure with mild pain and feasible in most cases. Adding VOH to the routine diagnostic work-up of infertile couples prior to laparoscopy seems to be a feasible, safe, simple, tolerable, and quick outpatient procedure. It can diagnose
intrauterine abnormalities in about a quarter of infertile wom-en with normal HSG. VOH has an additional value to HSG and DL in diagnosing uterine. Nevertheless, whether its use would increase pregnancy rate among infertile women re-quires a further longitudinal comparative study.