A 35-year-old Caucasian pregnant woman (G2, P1) presented at the antenatal department for a routine ultrasound scan following a positive pregnancy test. She was10 weeks and 4 days pregnant after in vitro fertilization (IVF). This was her second pregnancy. Her first pregnancy was delivered two years previously by caesarean section for breech presentation. Both of the pregnancies were achieved through IVF. During her caesarean section she had experienced pulmonary aspiration. Her ultrasound scan findings were reported as follows: A gestational sac with regular margin was seen at the right uterine fundus surrounded by myometrium (). Fetal pole was detectable, crown–rump length (CRL) was 40.8 mm () and fetal heart was positive. The patient was stable and she denied any discomfort, pain or vaginal bleeding. Her blood investigations on admission were as follows: Hb 13.1 g/dl; β-HCG 60530 IU/l; WBC 12430 10^3/μl. The diagnosis was discussed with the patient and the potential treatment was explained to her, emphasizing that, given her scan findings and blood results, a surgical approach, especially laparoscopic cornuostomy, might be more appropriate. The patient expressed her wish to preserve fertility and was reluctant to have surgery unless she became hemodynamically unstable because of her previous pulmonary aspiration. Therefore, conservative medical treatment was commenced. Methotrexate 100 mg i.v. was administered to the patient on day 1 of hospitalization, followed by folinic acid 10 mg i.m. the next day. On day 3 of hospitalization, blood investigations were repeated and the results were as follows: β-HCG 65953 IU/l; Hb 13.0 g/dl. The patient underwent a new ultrasound scan on the same day. During this scan, the fetal heart was undetectable. The new findings were discussed with the patient and an operation was suggested; however, she was still reluctant to have surgery. On day 4 of hospitalization, direct methotrexate injection into the gestational sac was performed under ultrasound guidance []. Three days after the methotrexate injection a new ultrasound scan was performed and the CRL measurement was seen to have decreased to 34.2 mm and (). The patient was hospitalized for 17 days in total and was given the methotrexate/folinic acid regimen twice more. During her conservative medical treatment the patient was stable and had no discomfort, vaginal bleeding or any drug side-effects. On day 16 of hospitalization β-HCG was 2051 IU/l and on the repeated scan the fetal pole was 28 mm. She was discharged on day 17 and she was asked to return for follow-up after 3 weeks. On follow-up, her β-HCG was 60.57 IU/l and her scan findings were reassuring as no fetal pole was detectable (). She was asked to return in 6 weeks for further follow-up. At her last follow-up visit, the uterus appeared to be normal and no gestational sac was seen () and β-HCG was 9.3 IU/l.