A 27-year-old woman, gravida 3, para 1, at 9 weeks gestation, initially presented with clinical and ultrasonographic features suggestive of a missed spontaneous abortion for which surgical evacuation was performed. A diagnosis of ectopic pregnancy was made as on histological review no fetal or chorionic tissue was seen. Medical management for an ectopic pregnancy was initiated. Following methotrexate administration she was readmitted with severe abdominal pain. Findings on diagnostic laparoscopy revealed an asymmetrically enlarged swollen fundus. Hysteroscopy was performed concurrently demonstrating an empty uterine cavity. A diagnosis of intramyometrial pregnancy was made based on these findings. An MRI scan was performed postprocedure which supported the diagnosis. In view of her parity and future fertility medical management was adopted with methotrexate. She was followed up until hormone levels returned to baseline and serial scans showed a healed solid collection.