Reproduction and fertility are central components to successful dairy enterprises, and an appropriate management and understanding of the physiological events needed for fertility is crucial to sustainable dairy farming. This chapter discusses the physiology of the main impediments to fertility and management issues that need to be addressed in order to ensure good fertility of dairy cows. It deals with parturition and uterine health, the importance of the post-partum environment and the role of oestrus, as well as methods of establishing pregnancy and the effect of heat stress on cows’ fertility. The chapter also examines fertility of heifers and the impact of genetics on fertility, and provides suggestions for further reading in this area.