The review summarizes recent developments in the preparation and use of new initiators for the ring opening polymerization of lactide. The review compares different classes of initiator including metal complexes, classed according to their group in the periodic table, and carbon-based initiators/organocatalysts. Emphasis is placed on the polymerization kinetics and the control exhibited by the different types of initiators. Where useful properties, such as high rates or stereocontrol, have been observed a more detailed examination of the initiator is provided. A further focus of the review is initiators displaying low toxicity and biocompatibility.