A 36-year-old Caucasian nulliparous healthy woman was referred to our outpatient clinic with a positive pregnancy test and complaints of progressive nausea, abdominal pain and irregular vaginal bleeding for 2 months. For 3 years, she had been using a levonorgestrel-releasing intrauterine device as a contraceptive, which was removed by the general practitioner the same day. She had no history of prior ectopic pregnancy, pelvic inflammatory diseases or previous tubal-uterine surgery, in vitro fertilization or other assisted reproduction procedures. She did not smoke. On examination, her blood pressure was 108/64 mmHg and she was afebrile. There was slight tenderness in her right lower abdominal quadrant. No guarding or rebound tenderness was noted, and no abdominal mass was palpable. Laboratory findings were: quantitative human chorionic gonadotropin (hCG) level of 69,030 mIU/mL, hemoglobin 7.9 g/dL (12.1-15.3 g/dL), white cell blood count 6.5 × 109/L and normal liver chemistry test. A two-dimensional transvaginal sonogram revealed a sac situated external to the endometrial cavity in the right cornua of the uterus (>1 cm from the most lateral edge of the uterine cavity) containing an embryo measuring 5 mm with positive heart rate consistent with a 6-week pregnancy. The sac had a thin surrounding myometrial layer. Neither free fluid nor adnexal mass were noted. Chlamydia tests on admission were negative. After informed consent, chemotherapy was preferred by the patient to either dilatation and curettage or laparotomy to preserve fertility. She was treated as having an ectopic, cornual pregnancy with chemotherapy. Four doses of intramuscular methotrexate (1 mg/kg) were administered followed by leucovorin (0.1 mg/kg) on alternate days to enhance destruction of trophoblastic tissue. In the following 2 weeks, the quantitative hCG level declined to 64% of its original value. The patient was discharged from hospital after signs of resolution of the ectopic pregnancy and was seen for follow-up until hCG levels were <5 mIU/mL and follow-up ultrasound findings did not reveal any abnormalities: normal uterine cavity, no adnexal mass, no abdominal fluid. Hysteroscopic evaluation showed the same: no abnormalities, both uterine openings open to fallopian tubes. There were no side effects to the methotrexate treatment.