Implantation of the fertilized ovum outside the uterine cavity is called ectopic pregnancy. It is associated with adverse outcome if not treated earlier. The fate of ectopic pregnancy depends on many factors. Important among them being site and duration of ectopic pregnancy. The main serious outcome is rupture. If the ectopic pregnancy ruptures and the patient survives this catastrophe, the ectopic mass gets organized and presents as pelvic mass with pain. Methotrexate is a folic acid analog that inhibits dihydrofolate reductase and thereby prevents synthesis of DNA. It affects actively growing cells including trophoblastic tissues, malignant cells, bone marrow, intestinal mucosa and respiratory epithelium. Medical management of ectopic pregnancies with methotrexate is safe and effective, therapy can be considered for patients with confirmed ectopic pregnancy who are hemodynamic ally stable with no evidence of rupture. It should be used with caution and severe toxicity should be kept in mind.