Methods of in vitro fertilization (IVF) have advanced dramatically since the first IVF baby was born in 1978. Originally yielding single-digit success rates, IVF is now successful in nearly 50% of cases in which the woman is younger than 35 years. Here, we describe the improvements in laboratory techniques and advances in our abilities to manipulate reproductive physiology that have facilitated this improvement. Additionally, we describe efforts to ensure safety standards in this competitive field.