We read with great interest the review article written by Timor-Tritsch and Monteagudo as we are in preparation of a review on the same topic. In our opinion systemic methotrexate (MTX) treatment is unique because it provides a noninvasive treatment option for patients seeking fertility preservation with relatively small amount of cost. The authors concluding that systemic methotrexate should be avoided as a single treatment option in the treatment of cesarean scar ectopic pregnancy. The authors found a complication rate of 62.1% based on 87 published cases derived from 34 different reports. We read the entire reference list of the article. We found that some references, were not reporting systemic MTX treatment and some were reporting systemic MTX as a part of a combination therapy. Some of the references should have been excluded because of a lack of knowledge on systemic MTX administration, including a report of twin pregnancy and a missed diagnosed case at the beginning of treatment. In our opinion, 23 of the cited 34 articles were related with the use of systemic methotrexate as a single first line treatment option on singleton pregnancies and there were 36 cases among those articles rather than 87 cases. Our evaluation showed 19 complicated cases, including 11 cases requiring major intervention and 8 minor interventions rather than 54 as stated. In addition, only 2 of the 8 cases with minor secondary intervention met the inclusion criteria provided by the review for acceptance as a complication (cases requiring 2 additional interventions). So, there were only a total of 13 cases meeting the complication criteria of the review. The overall complication rate should have been calculated as 36.1% (13/36) not 62.1% (54/87) according to the criteria stated in the review. Furthermore, we encountered 5 additional studies in the reference list of the article not cited among those 34 references. In conclusion, deciding to avoid systemic MTX treatment as a first line treatment option would be incorrect by a superficial assessment that will let patients undergo more invasive procedures. In our opinion, the treatment modalities should be analyzed by a good model of quantitative analyzes to provide an appropriate decision.