In this issue, Zhang et al. (2017) report the birth of a healthy boy after mitochondrial replacement therapy (MRT) by spindle transfer to prevent transmission of mitochondrial disease from mother to child. The case was first publicized in the lay press (Hamzelou, 2016; see also editorial by Johnson, 2016) and then presented during the 2016 Annual Meeting of the American Society for Assisted Reproduction (ASRM) in October 2016 (Zhang et al., 2016a). It followed an earlier report of an unsuccessful attempt at MRT by pronuclear transfer by the same group (Zhang et al., 2016b). This world-first birth represents an achievement and a steppingstone, and it has played a role in encouraging the Human Fertilization and Embryology Authority (HFEA) in the UK to issue a final recommendation that the technique ‘be approved for cautious use in specific circumstances’. (http://www.hfea.gov.uk/10559.html)

We, the editors, were unanimous in deciding that this paper should be published in RBMO, based on our conviction that the scientific community must be informed of the details of the work in full in order to evaluate it critically and discuss it openly. We decided this despite the fact that the work has weaknesses and limitations in a number of areas. Moreover, although we were able to encourage the authors to include more details of their work in the submission, some uncertainties concerning methodologies and results still remain. Here we outline our concerns regarding the approach and the treatment process described by Zhang and colleagues.