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Primary ovarian pregnancies are rare and comprise less than one percent of all ectopic pregnancies. Diagnosis can be difficult as an ovarian ectopic pregnancy may share similar features on ultrasound with those of a corpus luteal cyst. Findings on transvaginal ultrasound including a hyperechoic ring may denote the presence of a gestational sac and therefore an ovarian ectopic pregnancy. Ultrasonographical findings along with a high suspicion for an ovarian ectopic pregnancy are paramount. The report reviews the case of a 23-year-old primigravida with first trimester bleeding, an elevated human chorionic gonadotropin, an ovarian cyst, and no intrauterine pregnancy detected on ultrasound. The evaluation, diagnosis, and surgical management of an ovarian ectopic pregnancy are discussed.