Objectives: To evaluate the usefulness of employing laparoscopy to observe distal fallopian tube (FT) peristalsis and to compare its efficacy to the hysteroscopic viewing of proximal FT peristalsis in normal and hydrosalpingeal FT. Design: A prospective comparative cohort study. Patients and methods: One hundred and fifteen infertile women undergoing concomitant diagnostic or operative laparoscopy and hysteroscopy were divided into two groups. Group A comprised 59 cases with apparently normal FTs while group B comprised 56 cases with hydrosalpingies. Setting: Endoscopy unit of a tertiary university hospital. Methods: Fallopian tube status was assessed during diagnostic or therapeutic laparoscopy, including whether morphologically normal and patent or not. Whenever possible, monitoring of the distal ends of both FTs was performed to detect any potential peristalsis. The proximal portions of each FT were then subjected to hysteroscopy to assess proximal tubal peristalsis. The effectiveness of laparoscopy in assessing distal FT peristalsis and comparing its findings to the hysteroscopic assessment of proximal FT peristalsis in normal and pathologic FT were the primary outcomes. Results: Laparoscopic detection of distal tubal peristalsis either in normal or hydrosalpingeal FT was low [5 (4.2%) and 5 (4.4%)] in both groups, respectively. After the exclusion of cases with unilateral patent FT from group B, the percentage dropped to 3.2% (only three FT). Hysteroscopic detection of proximal tubal peristalsis was significantly higher in group A [80 (67.8%) vs 40 (35.7%)] in total group B. Conclusions: Laparoscopic evaluation of distal FT peristalsis, whether for healthy or pathologic FT, is of limited utility and is not advised. Its effectiveness is significantly lower than the hysteroscopic evaluation of proximal FT peristalsis.