Reproductive herd health programs of the 1960s and 1970s focused primarily on the control of infectious and noninfectious diseases of the reproductive tract, estrus detection, breeding technique, semen quality and handling, and endocrine imbalances. Despite veterinary intervention, conception rates dropped from 55% before this period to 45% after this period, but milk production increased greatly. Because studies have shown that the additional nutritional needs for high producing cows may be a factor limiting reproduction, bovine practitioners have become more involved with dairy nutrition. New emphasis has been placed on the concept of total production medicine with the anticipation that improved nutrition would improve reproduction. Because of a better understanding of the dynamics of energy in the dairy cow and its effect on reproduction, fertility examinations now include nutrition monitoring and body condition scoring. Several relationships between nutrition and fertility have been identified: high producing thin cows that drop 0.75 to 1.0 in body condition score resulting in anestrus; fat dry cows that develop fatty livers and associated postpartum disease; heifers that have good milk production but prolonged anestrus; dry cows with ration imbalances during the transition period that develop milk fever, retained placenta, displaced abomasum, metritis, or endometritis; lactating cows with disease in midlactation, especially feet and leg problems, resulting in lowered fertility; and healthy, lactating cows with poor conception that have high concentrations of urea N in blood or milk.