Abstract: Regulation of mitochondrial replacement therapy (MRT) in the United States must be understood against the backdrop of the regulation—and, in some cases, lack thereof—of other reproductive technologies. Moreover, given the proximity between MRT and sensitive ethical concerns, political debates over the right to procreate, access to abortion, and concern for fetal personhood provide crucial context. This chapter situates MRT in these larger contexts and juxtaposes the National Academies of Medicine’s proposal for MRT regulation in the United States with the way Congress has thus far regulated the technology by essentially enacting a prohibition via an appropriations rider. The authors also discuss the regulatory scheme surrounding funding for MRT research as the United States lags behind other jurisdictions in nationally available funding. A final part of this chapter considers additional legal and ethical issues raised by the prospect of MRT, including the threat of medical tourism to circumvent US prohibitions.