Objective <p>Hysterosalpingography (HSG) constitutes a radiological methodology for the assessment of the uterus and fallopian tubes in women experiencing infertility. Hysteroscopy (HSK) alone does not facilitate the evaluation of tubal patency or anatomical structure. However, the synergistic application of hysteroscopy with abdominal ultrasonography enables the assessment of tubal patency in at least one fallopian tube. Tubal flushing techniques may influence pregnancy rates in cases of infertility when contrasted with no intervention. The current study aim is to assess the pregnancy rate after tubal flushing using HSG versus combined hysteroscopy and two-dimensional ultrasonography (US).</p> Methods <p>We conducted a randomized controlled trial study from January 2024 to May 2025 involving infertile women presenting to the infertility clinics of Kafr Elsheikh and Alexandria Universities. Women were randomly divided into two equal groups. HSG was performed for the first group, while office HSK/US was performed for the second group. Both procedures were done between menstrual days 7 and 11. Patients were followed up to assess pregnancy and birth outcomes for 6 months postintervention.</p> Results <p>One hundred and eighty-two women were assessed for eligibility to be included. After eligibility screening, 160 women were randomly assigned into two equal groups (<i>n</i> = 80 each). HSK/US group achieved a significantly higher pregnancy rate (70%) compared to the HSG group (45%) (<i>P</i> = 0.024). No statistically significant differences were observed in spontaneous abortion, ongoing pregnancy, or live birth rates between the groups among those who conceived.</p> Conclusion <p>These findings strongly suggest that the incorporation of office hysteroscopy followed by an ultrasound examination into the comprehensive diagnostic workup for infertility cases has the potential to substantially improve subsequent pregnancy rates.</p>