Courteney Cox-Arquette: from Friends-ship to motherhood

On the popular show Friends, the characters of Monica and Chandler struggled with fertility issues. Like many real-life couples, the fictitious friends-turned-spouses tried to figure out where their problem with conceiving may lay. Is it the man's sperm? Is there something amiss in the woman's reproductive organs?

"Actually it's both of us," Chandler learns. "Apparently, my sperm has low motility, and you have an inhospitable environment." Monica questions this, to which Chandler responds, "It means my guys won't get off their Barcaloungers, and you have a uterus that is prepared to kill the ones that do."

Like those imaginary Friends, Courteney Cox-Arquette, the actress who portrayed Monica, and her husband, actor David Arquette, may have shared some laughs throughout their journey toward parenthood. But it was a journey filled with emotion, loss, pain, and perseverance.

"I get pregnant pretty easily," Cox-Arquette told People magazine, "but I have a hard time keeping them." Multiple miscarriages challenged the couple, but they bounced back again and again to try again.

When couples deal with infertility, sometimes the root problem is hard to detect. Doctors and fertility specialists will explore 4 possibilities: Is there a sperm problem? Is there an ovulation problem? Are the sperm and egg able to unite? Can the embryo implant and be sustained in the uterus?

The fourth possibility seemed to be to blame for Cox-Arquette's infertility. Cox-Arquette asserts that her difficulties originated from her body's overactive immune response to a fetus and causing miscarriages. The proteins thought to cause this reaction are called antiphospholipid antibodies. They are often present in the bodies of people with autoimmune disorders, like lupus, but they also exist in approximately 2% of the normal population. Some women take medications in order to suppress the immune response cells and allow an embryo to safely grow in the uterus.

As Cox-Arquette's 40th birthday approached, the couple decided to try in-vitro fertilization (IVF). "It's a fact that after a certain age you have less of a chance," Cox-Arquette has said. The couple also tried preimplantation genetic diagnosis (PGD), a test that checks embryonic cells for genetic abnormalities.

Monica and Chandler eventually decided to adopt. That's where truth strayed from fiction. After years of miscarriages and fertility treatments, Cox-Arquette and her husband, actor David Arquette, finally welcomed their daughter, Coco Riley Arquette, into the world on June 13, 2004. Although the couple divorced in 2013, they remain close and spend time together with Coco when they can.

Marcia Cross: desperate to be a mom

If you've ever seen Marcia Cross as perfectionist Bree Van De Kamp on Desperate Housewives or as the vengeance-crazed Dr. Kimberly Shaw on Melrose Place, you'd think, "Wow, that's a lady who gets what she wants." Upon meeting her husband, stockbroker Tom Mahoney, at the age of 42, Cross definitely knew what she wanted – a baby.

"Even before I was 30, I started thinking about [motherhood]," Cross has said. "The years started going by and I was anxious about the clock ticking." Before falling in love with Mahoney, Cross had at one point considering adoption. She also tried getting pregnant via a sperm donor. When she knew she'd be getting married, she didn't waste any time. Cross knew that she would need help conceiving. In fact, the couple opted out of a romantic honeymoon and instead began fertility treatments right after their wedding.

Cross has been noted for her openness in speaking about her infertility, calling much-needed attention to the fact that a woman's fertility sharply declines past 40. "It's very, very difficult to get pregnant in your 40s," the actress admitted. "I don't like the average woman being misled into thinking that fertility is something that goes on forever."

Cross also spoke out about the use of donor eggs among older women trying to conceive. "When a woman gets older, they get donor eggs, which doesn't make the baby any less beautiful or perfect. One's own eggs only last so long."

Though she has neither confirmed nor denied whether she herself used donated eggs, Cross definitely beat the odds, becoming pregnant with twins through in-vitro fertilization (IVF) at the age of 44. Fraternal twin daughters Savannah and Eden were born on February 20, 2007. To Cross, having babies later in life was "like a miracle... I didn't think it would happen."

Brooke Shields: an advocate for fertility issues

Since the '70s, Brooke Shields has been an enduring presence on TV and movie screens. Audiences have practically watched her grow up and go through the highs and lows of her career and her love life. But Shields' life took a serious turn in 2001. One after another, traumas piled on to the star – the death of her father, a struggle with infertility, and her very painful experience with postpartum depression after the birth of her daughter. For Shields, the path from Pretty Baby to baby bliss was a long and winding one.

Shields and her husband, sitcom writer Chris Henchy, knew that they wanted children – but they also knew it might be tricky. Months before their wedding, Shields found out that she had cervical dysplasia, an abnormal growth of pre-cancerous cells on the cervix. The procedure to remove the cells not only left scarring that caused her cervix to tighten and shorten, it also resulted in the loss of mucus glands that help to transport sperm. This difficulty Shields likens to "jumping in a pool with no water. There's nothing to help the little guys swim through."

Despite this impediment, the couple tried and tried for a year and a half to become pregnant on their own. By definition, couples are considered infertile if they've been unable to conceive after a year of regular, unprotected intercourse, or after 6 months if you're 35 or older. Since Shields was 36 at the time, her doctor advised the couple to try in-vitro fertilization (IVF).

Shields gamely went along with all of the requirements. She took the medications to prepare her body for IVF and the ones to stimulate her ovaries. She endured countless doctor visits and the estrogen patches that made Shields "look and feel like I'd had a skin graft when they were removed." Henchy helped out by giving Shields the hormone shots she needed. "The first time, I kneeled down, carefully put the needle in her butt and almost passed out," Henchy has said. "Three weeks later I was doing it with a coffee cup in one hand, not thinking about it."

Their shared effort resulted in a pregnancy, but it ended in a miscarriage. The couple continued IVF and had several failed cycles, during which Shields tried her best to keep perspective. "After a while, when you're not successful, you start to associate the word 'failure' every time you pee on a stick and it doesn't come out the right color. What starts out as a dream becomes a project that's all consuming."

Finally, in what the couple describe as a last-ditch attempt using four frozen embryos, Shields became pregnant again. This time it resulted in the birth of her daughter Rowan Francis Henchy on May 15, 2003.

After her experiences, Shields became an advocate for people dealing with infertility. "When you're having trouble conceiving, it's often tough to know where to turn for answers, and when you're undergoing fertility treatment, it's not always easy to find the support that you need," says Shields. "As natural as we'd all like it to seem, it's important for women to be aware of potential problems and to take control. Two eggs do not an omelette make."

The couple's second child, daughter Grier Hammond Henchy, was born in 2006. The second pregnancy did not require IVF treatments.

Celine Dion: her story, her dream

French-Canadian chanteuse Celine Dion wrote in her memoir, My Story, My Dream, that she never thought her life would fall apart without a child. "But even so," she wrote, "I was waiting for it, looking for it and making it part of my plans." Soon after she and manager René Angélil married in 1994, the couple decided to start trying to become pregnant.

Dion was young, in her mid-20s, healthy and active, and had no reason to believe that becoming pregnant would be a challenge. But after several years of trying, she was still not pregnant. After a year of regular, unprotected intercourse without a pregnancy, couples are advised to seek help from a doctor to conceive.

Then, in 1999, Angélil was diagnosed with cancer. Since the couple feared that chemotherapy and radiation might affect Angélil's sperm, they froze some for future use. It was at this time that they discovered that Angélil's sperm count was very low and lacked motility. Approximately a third of all fertility problems have a male factor component, and in Dion and Angélil's case, this was true. If they wanted to become pregnant, they would need the help of assistive reproductive technology (ART).

The family took some time to focus on Angélil's health and returned to their fertility treatments some months later. A procedure called intracytoplasmic sperm injection (ICSI) was recommended. This pinpointing method begins in the Petri dish, with a woman's individual eggs each injected with a single sperm. If fertilization occurs, the successful embryo is then implanted into the uterus. Dion gave herself daily injections to prepare her body for in-vitro fertilization (IVF) and to stimulate her ovaries. Eventually, 18 eggs were extracted from Dion's ovaries, and the ICSI process began.

One day, after 38 rounds of chemo and radiation, Angélil was told that he was cancer-free. And on that same day, Dion's fertility specialists surprised her with the words she'd been waiting for: "You're pregnant, Celine!"

On January 25, 2000, Dion gave birth to son René-Charles Dion Angélil. She mentioned that she would someday like to give René-Charles a little brother or sister. Aside from potential difficulties due to her age (Dion turned 40 in March 2008), this was still a possibility. During their initial fertility treatments, Celine and Rene had decided to freeze their unused embryos, in case they'd like to have another child someday. Cryopreservation is now offered by many fertility clinics.

Celine's wish to provide René-Charles with a sibling came true in December 2010 with the birth of fraternal twin boys, Nelson Angélil and Eddy Angélil. She became pregnant after the sixth attempt at IVF.