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A 30-year-old female underwent in-vitro fertilization and preimplantation genetic testing. The patient conceived after her first frozen embryo transfer (FET). Beta-hCG was measured at 85 and was doubling appropriately. Ultrasound showed an angular pregnancy with heart beat confirmed by MRI. The patient has a deep arcuate uterus which may have predisposed to angular pregnancy. She was given 3 doses of methotrexate unsuccessfully. Due to concern of rupture, she underwent a hysteroscopic injection of methotrexate inside the gestational sac at 7 weeks. Hysteroscopy showed the gestational sac within the angular portion of the uterus as well as the needle penetrating the gestational sac to inject the 50mg methotrexate (see video). Fetal heart rate ceased and the patient passed products of conception 1 week later. The patient had no further complications and had a normal pregnancy on her next FET that resulted in a livebirth.
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