Ectopic pregnancy has become a surgical epidemic over the past two decades. To minimize the morbidity, mortality, and financial burden created by this rapidly growing health problem, nonsurgical alternatives have been investigated, including treatment with methotrexate. We reviewed current literature to evaluate the safety, efficacy, and costs associated with methotrexate treatment of tubal pregnancy. To date, 17 studies have reported on 400 patients with tubal pregnancies treated with parenteral methotrexate; the overall success rate was 92% (95% confidence interval, 89% to 95%). Single-dose parenteral methotrexate has been shown to be safe, effective, and associated with minimal costs when used in carefully selected patients. A prospective, randomized clinical trial comparing medical and surgical management of ectopic pregnancy is needed to assess the risks, benefits, and costs of these two approaches.