The key to diagnosis of an ectopic pregnancy is determining the presence or absence of an intrauterine gestational sac with co-relation of serum β-hCG levels. An ectopic pregnancy should be suspected when TVUS does not show an intrauterine gestation with a serum β-hCG levels of 1500 IU/L higher. Women with ectopic pregnancies tend to have lower β-hCG levels than those with normal intrauterine pregnancies; however, twin ectopic pregnancies have high of β-hCG similar to normal intrauterine pregnancies. In our case, the β-hCG level was high (6927 IU/L) at the time of ultrasound examination.