The objectives of this presentation are to review results of our previous and on-going research with respect to the risk factors and consequences of poor reproductive performance in dairy cows, and to develop an economic framework to optimize decisions related to dairy cow reproductive performance. To make profitable breeding and replacement decisions, the farmer must account for factors including age, production level, lactation stage, pregnancy status, and disease history of the cows in the herd. Establishing the interrelationships among disease, milk yield, reproduction, and herd management is necessary for developing a decision model for disease treatment, insemination, and replacement. The data for the studies reviewed in this presentation incorporate health, production, and management components from Holsteins in the Northeast USA and Ayrshires from Finland. Data were analyzed using the Cornell Theory Center Supercomputer. The effect of risk factors on reproductive disorders was modeled with logistic regression, and on conception, insemination, and culling with survival analysis. The effect of reproductive disorders on milk yield was analyzed with mixed models. Economic optimization of reproductive performance was done with dynamic programming (DP). High milk yield, high parity, and calving in winter were risk factors for several reproductive disorders. These disorders, in turn, delayed insemination and conception in dairy cows, and some of them increased the risk of culling. Dystocia, retained placenta, and early metritis led to a short-term drop in milk production. High milk yield was not a major factor in delaying conception, except in first parity cows. However, higher yielders were more likely to be inseminated, and less likely to be culled. Non-pregnant cows had a higher risk of being culled. Reproductive performance of dairy cows influenced a herd's profitability, and good heat detection and conception rates provided opportunities for management control. It was not always economically advantageous to get cows pregnant as soon as possible, and there was no one optimal value for the calving interval length for all cows in a herd.