Background: Methotrexate presently finds application in the domain of gynecology for the therapeutic management of ailments stemming from trophoblastic tissue, notably encompassing ectopic pregnancy and gestational trophoblastic disease. This study is poised to fill a critical lacuna in medical literature, fostering a deeper understanding of Methotrexate's therapeutic potential and limitations when addressing ectopic pregnancies. Methods: Thepresent prospective observational design was meticulously executed within the esteemed confines of the Postgraduate Department of Obstetrics and Gynecology, ensconced within the esteemed premises of LallaDed Hospital, Government Medical College, Srinagar. A total of 120 patients were included in the study which spanned from 2020 to 2021. Results: The success rate of methotrexate treatment for ectopic pregnancies was 82.5%. The success rate decreased with increasing maternal age, with a success rate of 86.4% in the 25-29 age group, 82.8% in the 30-34 age group, and 75.0% in the 35-39 age group. Success rates varied by age, gravidity, ectopic pregnancy size, and initial β-hcg levels, with no statistically significant differences except for the size of ectopic pregnancies. Patients with 1-2 cm ectopic pregnancies achieved a remarkable 90.3% success rate, while those with 2-3 cm ectopic pregnancies had a lower 74.1% success rate. However, the overall success rate for all ectopic pregnancy sizes was 82.5%, with a significant difference based on size (P=0.019*). Patients with initial β-hcg levels of 1000-3000 had a 90.4% success rate, whereas those with levels of 3000-5000 had a 76.5% success rate. The overall study success rate was 82.5%, with a significant difference based on β-hcg levels (P=0.047*). Additionally, 19.2% of patients experienced side effects from Methotrexate treatment. The single dose methotrexate treatment was associated with mild side-effects, including fever, stomatitis, gastroenteritis, and deranged liver function tests, affecting 19.2% of the study population, but no severe side-effects were reported. Conclusion: Our findings emphasize that methotrexate serves as an effective medical management option for ectopic pregnancy, particularly in societies where preserving tubal function holds utmost importance. Its favorable success rate and relatively mild side-effect profile make it a valuable therapeutic approach, offering hope for successful outcomes in the management of this complex obstetric condition