I previously worked at a digital agency and one of my final projects was building the website for a large TV channel. At one point I had to have a meeting with the ad network to go through the integration.
The technical people involved didn't know anything about how their products worked or the implications of integrating them. No idea if they were blocking or async.
At one point I was trying to understand what, if any, changes I might need to make to handle their ads that did full background take overs. "No no no, it's an expanding mpu" - sure, fine, what does that even mean!?
(Don't get me started on having to swap using js for switching images in the gallery for using individual pages because the onmiture page tracking numbers were the metric that everything was measured by for selling ad space)
/rant
You'd think with all the smart people that have put their minds to ads on the internet, there would be lightning fast, targeted ads that actually worked by now.