Background: Laparoscopic salpingotomy is a well-established treatment for patients with tubal pregnancy who desire to retain fertility. Another approach that preserves the fallopian tube is medical treatment. This study aimed to evaluate the safety and efficacy of laparoscopic versus MTX treatment of well-selected cases of undisturbed ectopic pregnancy. Patients and methods: patients were divided into first group; 30 cases of undisturbed tubal pregnancy treated by MXT therapy. (25cases) by single dose and (5cases) by second dose: single dose regimen (MTX 50mg /m² IM) and second dose regimen. (MTX 50mg /m²IM) on 7th day. Second group; 30 cases of undisturbed tubal pregnancy treated by laparoscopic salpingostomy. Tubal patency tested after 8 weeks for all cases by hysterosalpingography. Outcome measures were treatment success, tubal preservation, homolateral tubal patency, and fertility potential after each treatment protocol. Results: There was a statistically significant higher frequency of tubal patency in methotrexate group compared to laparoscopic salpingostomy group, with p-value (p=0.007). Conclusions: Methotrexate is better than laparoscopic salpingostomy in treating undisturbed tubal pregnancy