As a young, aspiring art dealer, Ava Jerome met the talented and troubled artist Robert "Franco" Frank. They engaged in a romance until Ava discovered that she was pregnant. Franco was intrigued with the news and viewed his unborn child as a piece of art. Ava ended her relationship with Franco and kept him away from their daughter. Ava's belief in her decision was solidified over the years as Franco's art became more dark and disturbing and he was accused of several crimes. Ava raised her daughter Lauren Frank as Lauren "Kiki" Jerome and did not tell her about her father.
Years later when Kiki was a young adult, Ava pushed her daughter to visit her boyfriend in Port Charles. Kiki made the trip, unaware that Ava had lured her there to gain access to Kiki's inheritance after it was revealed that Franco was a member of the wealthy Quartermaine family. However, Ava's relationship with her daughter was placed on shaky ground after Kiki learned about her mother's deception and met her father and his Quartermaine relatives.
Ava was stunned when Franco was revealed to be alive and in Port Charles. Ava initially warned Franco to stay away from Kiki but changed her mind after she considered the power of his ELQ shares combined with Kiki's. Despite the alliance, Ava had no intention of facilitating a relationship between Franco and her daughter and she made an unsuccessful attempt on Franco's life. Instead a bystander, Olivia Falconeri, was shot. Franco surmised that Ava was behind the hit but she turned the tables on him by revealing that she knew he was behind the relish scandal that caused ELQ stock values to plummet.
Since Ava and Franco each had what the other wanted, they continued their association. Ava would reap the rewards of Franco's ELQ takeover and she would help Franco get to know Kiki. They pretended to date in order alleviate Kiki's wariness and to justify the amount of time they were spending together. Ava moved into the Quartermaine mansion with Franco and Kiki. As Ava settled into life in Port Charles, she ran into her former lover, Dr. Silas Clay. They spoke briefly and Ava reminisced their time together. Her attitude toward Silas became adversarial after he met Kiki. Silas asked Ava if he had fathered her child, but Ava lied about Kiki's age and insisted that she became pregnant well after they broke up. Kiki's boyfriend Morgan overheard the conversation and Ava was forced to admit that Silas was Kiki's father. Morgan planned to tell the truth until Ava convinced him otherwise.
Ava continued to gain access to ELQ and her intentions behind it were revealed when she met with her presumed deceased brother Julian. The siblings discussed their plans to take back their former territory which was now controlled by organized crime figure Sonny Corinthos. Julian had hoped that Ava would have already secured access to ELQ but was pleased to learn that instead she had fostered a relationship between her daughter and Sonny's son Morgan through an online gambling ring. Ava announced that Kiki was engaged to Morgan and that no one but Duke Lavery suspected that she was tied to the infamous Jerome crime family.
While Ava succeeded in pushing Kiki and Morgan together, she failed to keep the secret of Kiki's paternity. Silas learned the truth and was furious with Ava for her deception. Ava had hoped to rekindle her romance with Silas but he pushed her away. Ava was hurt but chose to focus on dismantling Sonny's organization. Ava spent time with Sonny under the guise of co-hosting a party to celebrate the marriage of their children. She learned that Sonny's mental health was strained by the recent death of his fiancé Connie Falconeri and Ava encouraged Sonny to discontinue his medication. Meanwhile, Julian destroyed a shipment of Sonny's on the night of the party. During the party, Sonny behaved erratically and announced that Morgan had married Kiki in haste before she learned that she was not related to Morgan's brother Michael. Kiki ended her marriage which devastated Morgan. He turned to Ava for comfort and they slept together.
Ava and Morgan carried on as lovers and she allowed Morgan to move in with her. She tried to keep Morgan in the dark regarding her family business but he overheard Derek admit that he was Ava's brother. Morgan also learned that Ava and Julian planned to overtake Sonny and he confronted them. Ava feared that Julian would eliminate her lover but instead Morgan joined their cause against his father and Ava and Morgan grew closer. However, Ava was careful to keep Morgan in the dark about her involvement in the death of Sonny's fiancé and she fueled Sonny's hatred of A.J. Quartermaine, the man who had been accused of Connie's murder.
As Ava manipulated Sonny, A.J.'s memories of the night of Connie's murder returned and he realized that Ava had killed Connie and framed him. Ava ordered Carlos Rivera to kill A.J. but the hit did not go as planned. Instead, A.J. confronted Ava in her home and Sonny walked in. He saw A.J. with his hands around Ava's neck and remembered when A.J. had threatened Connie. Sonny shot A.J. and Ava helped him cover up the crime. After A.J. passed away, Ava and Sonny hoped that they had gotten away with murder.
Ava became Sonny's confidant as he struggled with A.J.'s death. She convinced him to keep what they had done a secret and they engaged in a one-night stand. Morgan walked in on them afterwards and accused Sonny of stealing the woman he loved. Ava insisted that she loved only Morgan and tried to win him back. Her plans for Morgan were complicated after Julian threatened her life and she was forced to take refuge on Sonny's private island. Morgan interpreted her trip as a romantic tryst with Sonny.
Despite Morgan's interpretations, Ava's time with Sonny was not at all romantic. Sonny had learned the truth about Connie's death and he planned to watch Ava slowly bleed to death just as Connie had. As Sonny held a gun to Ava, she delivered the news that she was pregnant with either his child or his grandchild. After the pregnancy was confirmed, Ava hoped to reconcile with Morgan but Sonny demanded that she reside in his home until the child was born. He informed Ava that her life would end after the baby arrived. Ava continued to reach out to Morgan but he could not understand why she chose to live with Sonny.
Ava was desperate to get away from Sonny and she reached out to her mother. Delia attempted to steal a flash drive which contained Ava's confession that she had killed Connie. The endeavor was thwarted by Sonny which prompted Ava to make a deal with Julian. In exchange for her rescue from Sonny, she told her brother that Sonny had killed A.J. While residing with Julian, she learned that Luke Spencer was bankrolling her brother's operation and Ava offered to work for Luke as well.
Per Luke's orders, Ava was instructed to kill Kiki's boyfriend Michael. She chose not to carry out the order and instead hoped to evade Luke until she secured proof that Sonny had killed A.J. Meanwhile, Ava experienced cramping and sought treatment at the hospital where she had a strange encounter with Nurse Sabrina Santiago. Later, Sabrina paid Ava a visit and apologized for her behavior and delivered a prescription to her. Sabrina believed that Ava had been behind the car accident which had led to the death of Sabrina's infant son. Ava was unaware that Sabrina had tampered with the prescription in hopes of causing Ava to lose her child.
Ava continued to fear for her own life and the life of her unborn child after Sonny's men tried to kidnap her. With Jordan Ashford's help, she escaped but ran over an unidentified man. Jordan came to her rescue again and allowed Ava to leave while she took responsibility for the accident. Ava hoped to receive refuge from Kiki but instead was taken in by Morgan. Ava explained that she would not come between Morgan and his father again but he vowed to protect Ava and her child.
While Ava hid at the Brownstone she tried to keep her unborn child safe from Sonny, unaware that Silas' wife Nina Clay was also a threat. Nina had recently emerged from a twenty year coma and was angered to learn that Ava had given Silas a daughter and was pregnant again whereas Nina had miscarried her child with Silas years ago. Nina arrived and injected her with a substance which forced her to go into labor. Nina delivered Ava's daughter and claimed the child as her own. Nina's mother Madeline helped her escape with the newborn and Ava informed Nina that her mother had paid her to seduce Silas. The revelation did not stop Nina from taking the baby.