This review assesses the effectiveness of hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions in women with unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI). The review includes two parallel-design randomized controlled trials, one conducted in Italy and the other in Spain. The first study (Casini 2006) included 94 women with submucous fibroids and unexplained subfertility, and the second study (Pérez-Medina 2005) included 215 women with unexplained, male, or female factor infertility. The primary outcomes of live birth and hysteroscopy complications were not reported by either study. However, the hysteroscopic removal of polyps prior to IUI was found to increase the odds of clinical pregnancy compared to diagnostic hysteroscopy and polyp biopsy only (high-quality evidence). The review concludes that hysteroscopic myomectomy might increase the odds of clinical pregnancy in women with unexplained subfertility and submucous fibroids, but the evidence is inconclusive. More randomized studies are needed to confirm the effectiveness of hysteroscopic interventions in treating suspected endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions in women with unexplained subfertility or prior to IUI, IVF, or ICSI.This review assesses the effectiveness of hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions in women with unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI). The review includes two parallel-design randomized controlled trials, one conducted in Italy and the other in Spain. The first study (Casini 2006) included 94 women with submucous fibroids and unexplained subfertility, and the second study (Pérez-Medina 2005) included 215 women with unexplained, male, or female factor infertility. The primary outcomes of live birth and hysteroscopy complications were not reported by either study. However, the hysteroscopic removal of polyps prior to IUI was found to increase the odds of clinical pregnancy compared to diagnostic hysteroscopy and polyp biopsy only (high-quality evidence). The review concludes that hysteroscopic myomectomy might increase the odds of clinical pregnancy in women with unexplained subfertility and submucous fibroids, but the evidence is inconclusive. More randomized studies are needed to confirm the effectiveness of hysteroscopic interventions in treating suspected endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions in women with unexplained subfertility or prior to IUI, IVF, or ICSI.