The 243rd ENMC workshop met in Amsterdam, The Netherlands in March 2019 to discuss current perspectives and knowledge in reproductive options in patients with mtDNA-related mitochondrial disease. The 29 participants came from The Netherlands, UK, France, Germany, Spain, Austria, Belgium, Australia, USA and Brazil, and was multi-disciplinary, including patients, clinicians, basic scientists, ethicists, a sociologist, and representatives of industry and patient organizations (including the Lily Foundation, the Dutch Muscular Disease Association, International Mito Patients (IMP) and the LHON group of the Dutch Eye Association).