The establishment and maintenance of pregnancy in lactating dairy cows is a complex biological event that is influenced by a multitude of factors, from the reproductive biology of the cow to managerial aspects of the dairy farm. It is often mentioned in the scientific literature that fertility in dairy cows has declined concurrent with major advances in milk production. Some of this decline is attributed to the negative genetic correlation between milk production and reproduction. In the United States, yearly production per cow has increased steadily at a rate of 1.3% in the last decade and it is likely that this trend will continue in the years to come. At this rate, the average cow in the United States will be producing over 14 tons of milk per year in 2050 and technologies will have to be developed to allow these cows to reproduce to maintain the sustainability of dairy production. Despite high production, it is not uncommon for dairy herds with rolling herd averages for milk yield above 11,000 kg to overcome the challenges of reproduction and obtain satisfactory reproductive performance. Among other things, those herds have been able to mitigate some of the mechanisms that suppress reproduction in dairy cows such as extended postpartum anovulatory period, poor estrous detection, low pregnancy per insemination and, to a lesser extent, the high pregnancy loss. The success of those farms comes from an integrated approach to fertility that includes adequate cow comfort, elaborated transition cow management and nutrition, aggressive postpartum health monitoring program with preventative and curative measures to mitigate the negative effects of diseases on reproduction, and a sound reproductive program that includes manipulation of the ovarian cycle to allow for increased insemination rate. More recently, introduction of fertility traits in selection programs have created new opportunities for improved reproduction without neglecting economically important production traits. Applying nutrition and physiology to improve reproduction in dairy cattle