Our genome at conception determines much of our health as an adult. Most human diseases have a heritable component and thus may be preventable through heritable genome editing. Preventing disease from the beginning of life before irreversible damage has occurred is an admirable goal, but the path to fruition remains unclear. Here, we review the significant scientific contributions to the field of human heritable genome editing, the unique ethical challenges that cannot be overlooked, and the hurdles that must be overcome prior to translating these technologies into clinical practice. Our genomes at conception contribute substantially to our overall health, and heritable genome editing could provide many benefits by preventing disease from the beginning of life. Egli and colleagues review the scientific contributions to the field, the ethical challenges that cannot be overlooked, and the hurdles to be overcome prior to clinical practice.