Inclusion Criteria:  Diagnosed ectopic pregnancy was by Absence of an intrauterine gestational sac on vaginal ultrasound Coupled with β-hCG titers beyond the discrimination zone of at least 2,000 milli-International units (mIU/m).  Exclusion Criteria:  Patients had contraindications for letrozole Patients with any systemic disease ( diabetes, hypertension, ....) Patients with b-hCG levels >3,000 mIU/mL Patients with hemoglobin level <10 g/dL, Patients with platelets count <150,000/mL, Patients with elevated liver enzymes, Patients with elevated blood urea, or serum creatinine The presence of a fetal heartbeat in a gestational sac detected outside the uterine cavity