Reports of successful treatment of ectopic pregnancies by administration of methotrexate have recently attracted a great deal of attention. This review summarizes the results of therapy with methotrexate in tubal pregnancy. Different technical approaches and pharmacological doses have been reported. These methods, however, present various problems, including the occurrence of toxicity, long therapeutic periods and treatment failure. With proper selection of patients, a success rate of approximately 90% has been achieved. Preliminary assessment of subsequent fertility provides promising results. However, the majority of the reports do not include controls.