All women with history of secondary infertility after caesarean section will be subjected to office hysteroscopy according to Royal college of obstetrics and gynecology guidelines to diagnose any subtle uterine abnormalities not detected by conventional means.

Hysteroscopic examination will be done during the proliferation phase of the menstrual cycle.

The hysteroscopic evaluation will include assessment of the cervical canal, intrauterine lesions, the endometrium and the uterotubal junction. .

If hysteroscopy reveal a lesion, its type, size, location will be recorded. Transvaginal ultrasound will be done after the procedure to detect fluid in the douglas pouch to confirm patent tubes.

Asses the uterine scar in details.

Inclusion Criteria:

• Patients with secondary infertility more than 2 years after cesarean section.
• Normal semen analysis
• Normal hysterosalpingography or laparoscopy within 1year
• Evidence of ovulation by transvaginal ultrasound

Exclusion Criteria:

• • Cases with abnormal semen parameters.

  • Patients with abnormal hysterosalpingography.
  • Patients with anovulation.
  • Hormonal disturbances; high level of prolactin, thyroid hormone disturbances, very high or very low follicular stimulating hormone and luteinizing hormone
  • Patients known to be epileptic or with history of fits.
  • Cardiac patients ( valve diseases, ischemic, arrhythmic)

This study will include all secondary infertile cases after cesarean section who presented to infertility clinic at Women health Hospital, Assiut University