The dairy industry in the United States has changed dramatically in the last decade. Milk production per cow has increased steadily because of a combination of improved management, better nutrition, and intense genetic selection. Dairy farms are larger, and nearly 30% of the dairy cows in the United States are on farms with 500 or more cows. The shift toward more productive cows and larger herds is associated with a decrease in reproductive efficiency. Cows with the greatest milk production have the highest incidence of infertility, but epidemiological studies suggest that, in addition to milk production, other factors are probably decreasing reproductive efficiency in our dairy herds. The reproductive physiology of dairy cows has changed over the past 50 yr, and physiological adaptations to high milk production may explain part of the reproductive decline. Critical areas for new research include control of the estrous cycle, metabolic effects of lactation on reproduction, mechanisms linking disease to reproduction, and early embryonic mortality. Solving reproductive loss in dairy cows will not be easy because only a small number of research groups study reproduction in postpartum dairy cows. Therefore, the present research base will need to be expanded. For this to occur, research funding must be increased above its current level and a renewed emphasis must be placed on solving the emerging crisis of infertility in dairy cows.