Reduced reproductive performance of lactating cows during the summer is associated mainly with intensive genetic selection for high milk production, which places a great load on the thermoregulatory mechanism. In the last decades, a big effort has been made to explore the mechanism by which heat stress compromises fertility. The data gained so far revealed that the effect of thermal stress on the female reproductive tract is multifactorial in nature. Based on this understanding, new strategies to mitigate the effect of heat stress have been developed. The review summarizes some of the physiological responses of the cow to elevated temperature and discusses its limitations to maintain normothermia. The review emphasizes that cooling is the predominant strategy used today to alleviate the effects of heat stress. Findings from the Israel dairy herd indicate that efficient cooling management can improve milk production during the summer to a similar level of the winter, expressed by summer to winter ratio of 0.98. However, cooling as a singular approach cannot eliminate the decline in reproduction. Nonetheless, an efficient cooling system is a prerequisite for any other strategy. The review suggests additional hormonal treatments to improve reproductive performance during the summer. Given the complexity of heat stress effects on reproduction, comprehensive reproductive management during the summer is suggested, that is combining two or more strategies in a programme, might be more beneficial.