Two patients were selected for medical treatment with single dose methotrexate. One had treatment failure. Both did not meet the recommended inclusion criteria for this therapy (ectopic gestation size > 4 cm) but they and their family wanted to try conservative management as they wanted to retain their fallopian tubes and fertility potential, accepting the risk of failure. Stovall’s study shows a 3.3% incidence of rupture even in patients who did meet the selection criteria.