Challenges limiting reproductive efficiency of high milk-producing cows include interrelationships among body condition, dry matter intake, transition from the dry period to lactation, onset of normal estrous cycles, detection of estrus, and embryonic survival. Attention is required to details associated with diet formulation; feed bunk management; cow comfort in free stalls, holding pen, and milking parlor during extremes of temperature and humidity; proper hoof care; milking management and mastitis prevention; control of ovulation and estrus; and early nonpregnancy diagnosis. Intensive management of transition cows should involve monitoring key metabolic markers using hand-held devices. This should allow early detection of illnesses that can be followed by proven interventions to alleviate their residual effects. Body condition should be monitored more closely to reduce dry cow and transition problems and prevent prolonged anestrus by maximizing early postpartum dry matter intakes. Cow comfort should be monitored more closely to minimize standing time for milking, maximize standing time for estrus and feed intake, and maximize resting time for rumination and more efficient milk synthesis. Estrus may be detected using automated techniques such as pedometry, rump-mounted pressure-sensitive radio-telemetric devices, and in-line parlor tests for milk progesterone or estrogen. More highly fertile heifers may be impregnated using sexed semen, sexed embryos, or clones to provide more replacement heifers because of declining fertility of lactating cows. Strategies to impregnate high-producing cows will require more ovulation control before first and subsequent services without detection of estrus. Because of high rates of embryonic death, more pregnancies may be achieved by using sexed or cloned embryos. Many reproductive technologies used today, including programmed breeding, will be refined and incorporated into the management of cows on fewer dairy farms with more cows per farm. Despite trends for longer lactations associated with bST and lesser pregnancy rates, renewed lactations following parturition will continue to be essential for herd longevity of cows.