Uterine perforation is one of the risks of operative hysteroscopy. Although usually performed alone, laparoscopy has been recommended to aid the surgeon in preventing uterine perforation at the time of operative hysteroscopy.Since women suffering from infertility or habitual abortion with known or suspected intrauterine pathologic factors are at low risk for secondary pelvic abnormalities, we have been using ultrasound for control during operative hysteroscopy in these women. One hundred twenty-eight women underwent ultrasound-guided operative hysteroscopy.There were no complications, such as uterine perforation, during or after any of the procedures.Women with known intrauterine pathologic factors should be offered operative hysteroscopy controlled by ultrasound, avoiding the use of unnecessary laparoscopy.