The aim of this study was to evaluate the efficacy of methotrexate as second-line treatment for ectopic pregnancy. Oral methotrexate was used in 15 patients with evidence of persistent trophoblast after conservative laparoscopic surgery for tubal pregnancy. The treatment was successful in 14 of 15 cases, and the mean time for decline of serum hCG to nonpregnant levels was 24 days. In the remaining case, hCG continued to rise. Side effects were noticed, even at a low dosage, but only in those subjects not receiving citrovorum rescue. As an alternative to a second operation, oral methotrexate appears to be an effective and well-tolerated therapy for persistent trophoblast.