Reproductive performance in sows can be impeded by sub-optimal management or by disease challenges. Synchronizing estrus in a group of sows makes management easier. Weaning of sows should naturally synchronize sows, but delays or failures to return can occur due to environmental, management, or genetic variables. Some of the pharmaceutical methods to control estrus are administering PG600 on the first day after weaning, feeding Matrix® for 7 days after weaning, or Ovugel® 24 hours before inseminating. Feed intake during lactation is also a factor in returning to estrus. Four basic feed intake patterns are increasing throughout, low throughout, initially low then gradually increasing, and initially increasing then dropping off. The last three patterns have more problems returning to estrus than the first, and a rapid drop off in feed intake is often seen in primiparous sows. There are multiple diseases that can impact reproductive performance, and can cause an increase in mummies, stillborns, and/or abortions. Finally, management can affect reproductive performans. For example, a sow has discharge and a return to estrus after breeding has often been bred post-ovulation, and the uterus is susceptible to infection at this time. A combination of lactation feeding, disease control, and management strategies can reduce problems associated with reproductive performance, and pharmaceuticals can be a useful tool as well.