Today, serial serum hCG measurements and high-resolution transvaginal ultrasound (TVS) can provide early diagnosis of most ectopic pregnancy (EP) allowing more conservative options, like medical treatment with Methotrexate (MTX) or expectant management. We reviewed the experience of our Early Pregnancy Unit (EPU) in diagnosis and treatment of tubal EPs. We performed a review of all women who presented to our EPU in the study period with a TVS diagnosis of tubal EP. In EPU EPs are managed according to a strict protocol including a full evaluation of clinical, sonographic and biochemical (hCG) data. Surgery is performed only if: clinical presentation suggests rupture (severe pain, significant hemoperitoneum on scan, haemodynamycal instability), non-compliance or failure of conservative treatment (MTX or expectant). In all other the serum hCG ratio (hCG at 48 hrs/hCG at presentation) is determined: if > 1.0 (evolving EP) women are treated with MTX in a single-dose i.m., if < 1.0 (failing EP) women are offered expectant management with weekly serum hCG. Success was defined as an uneventful decline of the hCG to pre pregnancy levels with the primary intervention. 1,395 consecutive women underwent TVS in the EPU. 60 (4,3%) tubal EPs were diagnosed. Median age (years) was 30 (IQR 24–35), median gestational age (days) at diagnosis was 47 (IQR 40–54), median serum hCG level (IU/L) at presentation was 907 (IQR 317–2217). 25 (42%) were treated surgically from the onset, 13 (22%) were treated with MTX, 22 (36%) were managed expectantly. Two women had laparoscopy as a failure of MTX and expectant management respectively. Success rates of MTX and expectant management were 92% and 95%, respectively. Today most EPs can and should be managed non-surgically. Early diagnosis, together with a strict protocol incorporating a full clinical, sonographical and biochemical evaluation allow the avoidance of laparoscopy in most cases, and can optimize success rates of MTX and expectant management.