As a rare form of ectopic pregnancy, interstitial pregnancy threatens the future fertility of the patient. Methods of management include observation only, medical treatment with methotrexate either systemically or locally, or surgery either with laparotomy or laparoscopy. We present the case of a woman with recurrent interstitial pregnancy. Treatment with methotrexate was successful in her first interstitial pregnancy, however the second necessitated laparotomy. Selection of patients for treatment with methotrexate and the importance of subsequent tubal investigation are emphasized.