The relationship between inflammation and general health conditions in dairy cows and the link between inflammation, liver function, and fertility are poorly understood. To clarify these relationships, 120 multiparous dairy cows were followed throughout an entire lactation. Blood samples were collected during the first month of lactation for a metabolic profile, and milk yield, disease occurrence, and fertility parameters were monitored during the entire lactation. Twenty-four cows were culled, and another 19 were excluded because they had serious problems after 30 d in milk (DIM) and before the first insemination. The remaining 77 cows were pregnant at the end of lactation and were retrospectively grouped into quartiles based on liver activity index (LAI), which is based on plasma negative acute phase proteins. Cows in the lower (LO) and intermediate lower (INLO) quartiles of LAI had more severe inflammations with high concentrations of haptoglobin (0.77 and 0.61 g/L) and globulin (42.5 and 39.0 g/L), respectively, during the first week of lactation compared with cows in the upper (UP) and intermediate upper (INUP) quartiles of LAI (haptoglobin: 0.28 and 0.45 g/L, and globulin: 34.2 and 36.9 g/L, respectively). At 7 DIM, the cows in LO and INLO had greater bilirubinemia (8.7 and 10.5 vs. 6.3 microM/L in UP) and lower blood urea (3.5 and 3.7 vs. 4.1 mM in UP). The INLO group exhibited more days open (139 vs. 93) and services per pregnancy (2.68 vs. 1.65), but lower milk yield (38.3 vs. 40.8 kg/d at 28 DIM) compared with UP. The LO group did not have a significantly lower fertility status, but presented the lowest milk yield (34.1 kg/d at 28 DIM). Our data suggest that cows with lower LAI scores had a more pronounced inflammatory status during the first month of lactation, an impairment of usual hepatic functions (e.g., bilirubin clearance), and a larger negative energy balance. The same cows had poorer performance (lower milk yield and fertility) than cows with higher LAI scores. Overall data suggest that any effort to avoid the acute phase response in the transition period would be useful for optimizing the productive and reproductive performance of high-yielding dairy cows.