Much progress has been made in the reproductive efficiency of lactating dairy cows across the USA in the past 20years. The standardisation of evaluation of reproductive efficiency, particularly with greater focus on metrics with lesser momentum and less lag-time such as 21-day pregnancy rates (21-day PR), and the recognition that subpar reproductive efficiency negatively impacted profitability were major drivers for the changes that resulted in such progress. Once it became evident that the genetic selection of cattle for milk yield regardless of fertility traits was associated with reduced fertility, geneticists raced to identify fertility traits that could be incorporated in genetic selection programs with the hopes of improving fertility of lactating cows. Concurrently, reproductive physiologists developed ovulation synchronisation protocols such that after sequential treatment with exogenous hormones, cows could be inseminated at fixed time and without detection of oestrus and still achieve acceptable pregnancy per service. These genetic and reproductive management innovations, concurrently with improved husbandry and nutrition of periparturient cows, quickly started to move reproductive efficiency of lactating dairy cows to an upward trend that continues today. Automation has been adopted in Israel and European countries for decades, but only recently have these automated systems been more widely adopted in the USA. The selection of dairy cattle based on genetic indexes that result in positive fertility traits (e.g. daughter pregnancy rate) is positively associated with follicular growth, resumption of ovarian cycles postpartum, body condition score and insulin-like growth factor 1 concentration postpartum, and intensity of oestrus. Collectively, these positive physiological characteristics result in improved reproductive performance. Through the use of automated monitoring devices (AMD), it is possible to identify cows that resume cyclicity sooner after calving and have more intense oestrus postpartum, which are generally cows that have a more successful periparturient period. Recent experiments have demonstrated that it may be possible to adopt targeted reproductive management, utilising ovulation synchronisation protocols for cows that do not have intense oestrus postpartum and relying more heavily on insemination at AMD-detected oestrus for cows that display an intense oestrus postpartum. This strategy is likely to result in tailored hormonal therapy that will be better accepted by the public, will increase the reliance on oestrus for insemination, will improve comfort and reduce labour by reducing the number of injections cows receive in a lactation, and will allow for faster decisions about cows that should not be eligible for insemination.