Objective: To analyze the cost‐effectiveness of virtual sonographic hysteroscopy (VSH) performed before in vitro fertilization (IVF) (Scenario 1), frozen embryo transfer (Scenario 2), and oocyte donation (Scenario 3) attempts. Methods: A retrospective analysis of data extracted from patients' files was conducted. Before undergoing the assigned treatment, VSH was offered to all patients. Cost‐effectiveness was calculated on the basis of cost per live birth. The total cost was compared with a control group of patients who declined to have hysteroscopy before their treatment. Results: A total of 292 women were involved. Virtual sonographic hysteroscopy was performed in 192 women. Conventional operative hysteroscopy was subsequently required in 34 of them (17.7%). Subsequent assisted reproduction attempts resulted in live birth in 111 women—34/69 (49.3%), 35/69 (50.7%), and 42/54 (77.8%) in Scenarios 1, 2, and 3, respectively. This compared favorably with 100 women who declined VSH, with live birth achieved in 15/39 (38.5%), 14/37 (37.8%), and 15/24 (62.5%) in Scenarios 1, 2, and 3, respectively. The overall cost‐effectiveness of VSH compared favorably with straightforward treatment performed without this test. Conclusion: The overall cost‐effectiveness of treatment attempts carried out after previous VSH compared favorably with straightforward treatment performed without this test. Synopsis: Virtual sonographic hysteroscopy, when performed before an assisted reproduction attempt, reduces the cost per live birth, while avoiding more invasive conventional hysteroscopy in most patients. [ABSTRACT FROM AUTHOR]