Early pregnancy failure is a common pregnancy complication. This article reviews the efficacy of medical management of early pregnancy failure. Nonsurgical treatments, including expectant and medical management, are reasonable alternatives to surgical management depending on the clinical situation and the patient's requests. Possible regimens in medical management of early pregnancy failure include misoprostol alone or mifepristone in conjunction with misoprostol. However, many studies of medical management may underestimate success rates due to inconsistent inclusion criteria, different dosing regimens, and varying definitions of failed treatment. Clinicians need to understand the range of efficacy of these regimens to provide appropriate counseling to patients.