Background: Extra uterine pregnancy is frequently detected early on, changing into a more benign disease before the patient's condition worsens. Objective: The current study aimed to evaluate the effectiveness of methotrexate (MTX) with letrozole in treating women who had tubal ectopic pregnancies. Patients and methods: A controlled clinical trial was carried out at the Zagazig University Hospitals' Obstetric and Gynecological Department and Maternity Hospitals, and Menia ElQamh Central Hospital in the period from February 2022 to September 2022. A total of 30 women were equally divided into two groups; First group (control group) received MTX to treat medically assisted tubal ectopic pregnancy, while the second group (study group) received both Letrozole and MTX to treat medically necessary tubal ectopic pregnancy. Result:  In control group, median hCG at Day 0 was 1331, at Day 4 had a value of 645, at Day 7 had a value of 315.5, and at Day 14 had a value of 39. In study group median hCG at Day 0 was 856, at Day 4 recorded 412, at Day 7 recorded 114, and at Day 14 recorded 29. Success in control group reached 75%, while in study group it reached 86.7%. B-ideal hCG's cutoff value at day 4 was >1188 and on day 7 was >605. The tests' sensitivity, specificity, PPV, NPV, and accuracy were all successful (100%). Conclusion: Letrozole has a higher resolution rate and a better safety profile when compared to chemotherapy in treating women who had tubal ectopic pregnancies. More study should be conducted on drugs such as MTX.