Fertility in dairy cows has declined over the past five decades as milk production per cow has increased. Many hypotheses have been proposed to explain this including issues of genetics, physiology, nutrition and management, and these factors have been investigated at the animal, organ and cellular level at critical time points of the productive life of dairy cows. This paper reviews the physiological events and their causes and consequences affecting fertility in dairy cows and summarises these in a downloadable poster. We consider the following points to have the greatest negative impact on fertility and that they need to be prioritised in efforts to ameliorate the problem (others have been included in the review). Firstly, minimise negative energy balance and resolve any infection of the post partum uterus. Secondly, expression and detection of oestrus followed by insemination with high quality semen (day 0). Thirdly, ovulation and fertilisation of a high quality oocyte (day 1). Fourthly, an early increase in progesterone secretion from the corpus luteum (days 3-7). Fifthly, the uterine endometrium must produce an early and appropriate environment to stimulate embryo development (days 6-13). This leads to sixthly, a large embryo producing adequate quantities of interferon tau (days 14-18) that alters uterine prostaglandin secretion and signals maternal recognition of pregnancy (days 16-18). Future strategies to improve dairy cow fertility are needed for the benefit of the dairy industry and for cow welfare and should be based upon an integrative approach of these events. (C) 2011 Elsevier B.V. All rights reserved.