Ectopic pregnancy remains an ever-increasing health problem. Its incidence continues to rise, paralleling the progressive increase in the incidence of its etiologic factors, especially sexual transmitted diseases and assisted reproductive technologies for the treatment of infertility. Because of this, clinicians must be alert to the possibility of ectopic pregnancy in all women of reproductive age. Early confirmation of intrauterine pregnancy by measurement of serial hCG and transvaginal ultrasound when hCG levels reach 1,500-2,000 mlU/ml in women with risk factors is essential. Use of serum progesterone in the symptomatic patient may also clarify the diagnosis, allowing prompt curettage and frozen section analysis for villi when the level is below 5 mg/ml and heightened suspicion when between 5-25 mg/ml. Although, the standard of care for ectopic pregnancy is currently surgical, medical therapy with methotrexate is becoming progressively more common and more desirable. Besides being less invasive and associated with significantly lower risks, the administration of methotrexate therapy for ectopic pregnancy results in significant cost savings, which Morlock et al have calculated to be approximately $3000 per treated patient. However, most studies have not considered the cost incurred to treat the side effects nor the complications and failure of the medical management, nor the quality of life and patients’ preference. When successful, methotrexate treatment for ectopic pregnancy is very desirable from the economic, social and patients’ perspective. However, when medical therapy fails, the consequences may be quite catastrophic. Our goal is to identify those patients with ectopic pregnancy that are most likely to respond to methotrexate therapy and least likely to develop significant side effects. The elegant study by Lipscomb et al has clearly defined for us the predictors of success of methotrexate treatment in women with tubal ectopic pregnancy. When our patients with ectopic pregnancy present with low serum levels of hCG (< 5000 IU/L) and Progesterone (< 10 mg/ml) and absence of fetal cardiac activity, we can expect a success rate with single dose methotrexate to exceed 90%. All other patients may best be served with a “2 dose” regimen or surgical treatment, which should be minimally invasive and least traumatic to the reproductive organs. Whether treated by laparoscopic slapingostomy or systemic methotrexate, patients have a similar prognosis for tubal patency, repeat ectopic and future successful pregnancies. Modern diagnostic advances and minimally invasive treatment modalities coupled with the improved success rates of assisted reproductive technologies should reduce the morbidity and the mortality associated with ectopic pregnancy and offer the affected couple a much more optimistic outlook for subsequent reproductive potential.