Significant numbers of infertile women have congenital anomalies or anatomical distortion of the fimbrial-gonadal mechanism in their otherwise healthy oviducts. The diagnosis and surgical treatment of multiple congenital accessory tubal ostia, the elongated fimbria-ovarica syndrome, and management of paratubal cysts is described. Microsurgical correction of these defects was followed by term pregnancies in 46%, 57% and 28% of the three entities respectively and this data indicates that significant numbers of women with these defects may be helped by microsurgery. Failure to recognize these abnormalities may otherwise result in patients being diagnosed as idiopathic infertility, a decision which may exclude them from the possibility of undergoing a successful form of microsurgical treatment.