Maria Menounos Fertility and Health Journey: A Clinical Timeline

What Happened: The Public Timeline

Maria Menounos went public about her meningioma diagnosis in 2017, a disclosure she made while also revealing that her mother was battling stage 4 brain cancer. The timing was striking and shaped much of how she has since framed her advocacy work.

She has spoken on her podcast "Better Together with Maria Menounos" and in television interviews about the years between diagnosis and motherhood, a stretch that included surgery, recovery, and the decision to pursue surrogacy rather than carry a pregnancy herself. In 2023, her gestational surrogate delivered Athena, making Maria a mother at 45.

The clinical through-line in her story is one many women share: a serious illness, treatments that affect hormonal and reproductive function, and the navigation of family-building options under medical constraint.

What She Has Said Publicly

Maria has described the surrogacy process as emotionally difficult and logistically complex. In interviews with outlets including NBC's Today, she spoke about grief over not being able to carry her own child, the strain the journey placed on her marriage to Keven Undergaro, and the ultimately profound experience of becoming a mother through a gestational carrier.

She has not publicly detailed which specific fertility medications she used during the IVF retrieval cycle that produced Athena's embryo, which is relevant for women wondering "what does Maria Menounos take." The clinical inference, labeled clearly here as inference, is that a standard ovarian stimulation protocol would have been used, as is required in any IVF cycle preceding gestational surrogacy.

What Is Inference vs. Direct Statement

This is an important distinction, and one that deserves honesty. Maria has confirmed: the meningioma diagnosis, cranial surgery, the decision to use a surrogate, and the 2023 birth of Athena. She has not publicly disclosed: her specific fertility treatment protocol, her FSH or AMH levels, whether she pursued fertility preservation before or after surgery, or whether she takes any ongoing hormonal or fertility-related medications. Anything clinical in this article beyond those confirmed facts is drawn from peer-reviewed literature on fertility after brain tumor treatment, not from Maria's own disclosures.

How Brain Tumors and Their Treatment Affect Female Fertility

A meningioma is a tumor arising from the meninges, the layers of tissue surrounding the brain and spinal cord. Meningiomas are more common in women than in men, with roughly a 2:1 female-to-male ratio, a disparity linked to sex-hormone receptor expression on tumor cells. Grade 2 meningiomas, like Maria's, are classified as atypical and carry a higher recurrence risk than grade 1 tumors.

The Hypothalamic-Pituitary-Gonadal (HPG) Axis

The hypothalamus and pituitary gland sit inside the skull. Any intracranial surgery or radiation in that region can disrupt the HPG axis, which is the hormonal feedback loop that governs ovulation, menstruation, and fertility. Hypopituitarism occurs in a measurable percentage of patients after intracranial surgery, with some series reporting gonadotropin deficiency in 20-40% of cases depending on tumor location and operative approach. Maria's meningioma was located in a region she described as near the pituitary, which makes this a clinically relevant consideration.

Gonadotropin deficiency means the pituitary fails to produce adequate LH and FSH. No LH surge, no ovulation. No FSH signal, no follicle development. A woman can appear outwardly well and still have an ovulatory disorder driven entirely by pituitary damage.

Corticosteroids and Ovarian Function

Women undergoing brain surgery commonly receive dexamethasone to reduce cerebral edema. High-dose glucocorticoids suppress the HPG axis by inhibiting GnRH pulsatility at the hypothalamic level, leading to transient or sometimes prolonged menstrual irregularity. This is a mechanism rarely explained to patients in the neurosurgical consent process, yet it directly affects reproductive planning.

Antiepileptic Drugs

Some meningioma patients are prescribed antiepileptic drugs perioperatively. Enzyme-inducing antiepileptics such as phenytoin and carbamazepine accelerate the hepatic metabolism of estradiol and progesterone, potentially reducing the efficacy of hormonal contraceptives and altering cycle regularity. Whether Maria required antiepileptic medication is not publicly known.

Radiation Therapy

Grade 2 meningiomas often require adjuvant radiation. Fractionated radiotherapy to the skull base carries a documented risk of radiation-induced hypopituitarism. A systematic review found that radiation-induced hypopituitarism affects 30-70% of patients treated for brain tumors, with gonadotropin deficiency being one of the more common deficiencies. The risk is dose-dependent and may not manifest for years after treatment.

Fertility Preservation Before Brain Tumor Treatment

For any woman of reproductive age facing brain surgery, radiation, or chemotherapy, the question of fertility preservation should be addressed before treatment begins. ASCO guidelines recommend that oncologists discuss fertility preservation with all patients of reproductive age at the time of cancer diagnosis, before treatment starts.

Embryo and Oocyte Freezing

Embryo cryopreservation (freezing embryos created via IVF) and oocyte cryopreservation (freezing unfertilized eggs) are the two established, non-experimental options. The American Society for Reproductive Medicine (ASRM) designates oocyte cryopreservation as no longer experimental, with live birth rates per thawed oocyte in the range of 2-12% depending on age.

A standard ovarian stimulation protocol for egg retrieval takes approximately 10-14 days, which may be feasible even before urgent surgery depending on the clinical timeline.

Age and Ovarian Reserve

Maria was approximately 39 at the time of her 2017 diagnosis. Ovarian reserve, measured by antral follicle count and AMH, declines steeply after age 35, with AMH dropping roughly 6% per year in women in their late 30s. A 39-year-old facing intracranial surgery has limited time to make fertility decisions. Whether Maria pursued egg or embryo freezing at that stage is not publicly known.

What Is Gestational Surrogacy? A Clinical Breakdown

Gestational surrogacy means the baby is genetically related to the intended parent or parents. The intended mother's eggs (or donor eggs) are fertilized via IVF, and the resulting embryo is transferred to the gestational carrier's uterus. The carrier has no genetic relationship to the child.

This is clinically distinct from traditional surrogacy, in which the surrogate's own egg is used and she is the genetic mother. Traditional surrogacy is legally and ethically more complex, and most U.S. Reproductive attorneys and fertility clinics do not support it.

The IVF Process for the Intended Mother

If Maria used her own eggs to create Athena's embryo (which she has not explicitly confirmed but which is the most clinically consistent reading of public statements describing Athena as her genetic daughter), she would have undergone a full ovarian stimulation cycle. That process typically involves:

1. Baseline ultrasound and bloodwork (day 2-3 of the menstrual cycle)
2. Gonadotropin injections (FSH, such as follitropin alfa, or FSH plus LH, such as menotropins) for 8-12 days
3. Monitoring via transvaginal ultrasound and serum estradiol every 2-3 days
4. A trigger injection (hCG or GnRH agonist) to induce final oocyte maturation
5. Transvaginal egg retrieval under light sedation, 36 hours after trigger
6. Fertilization with partner sperm and embryo culture for 5-6 days to blastocyst stage
7. Embryo biopsy for preimplantation genetic testing (PGT) if elected
8. Embryo cryopreservation, followed later by frozen embryo transfer (FET) into the surrogate's uterus

The Society for Assisted Reproductive Technology (SART) reports that for women aged 40-42 using their own eggs, the live birth rate per intended egg retrieval is approximately 15-19%. For women over 42, it drops further, which is why many women in this age group use donor eggs.

The Gestational Carrier's Protocol

The surrogate undergoes a separate medical protocol to prepare her uterine lining for embryo transfer. This typically involves oral or transdermal estradiol for 10-14 days to thicken the endometrium, followed by progesterone supplementation (vaginal suppositories, intramuscular injections, or a combination) starting approximately 5 days before a day-5 blastocyst transfer. Progesterone support continues through the first trimester, usually until 10-12 weeks of gestation, to support early placentation.

Legal Considerations

Surrogacy law varies dramatically by U.S. State. California, Nevada, and Washington are generally considered favorable surrogacy states. Michigan and Louisiana, by contrast, have statutes that complicate or restrict compensated surrogacy arrangements. International surrogacy adds a layer of citizenship and legal parenthood complexity. ASRM's Ethics Committee has published guidance on the ethical considerations of gestational surrogacy, including the importance of independent legal representation for both parties.

Hormonal Health After a Brain Tumor: What Women Need to Know

A meningioma diagnosis and its treatment can alter a woman's hormonal status in ways that persist long after the acute illness is resolved.

Menstrual Cycle Changes

Women who experience HPG axis disruption after intracranial surgery or radiation may notice irregular cycles, anovulatory cycles (cycles without ovulation), or secondary amenorrhea (absence of periods for three months or more). These changes are frequently attributed to stress or weight fluctuation rather than recognized as signs of hypothalamic or pituitary dysfunction. A basal serum FSH, LH, estradiol, prolactin, and AMH panel is the appropriate starting investigation.

Premature Ovarian Insufficiency

High-dose radiation to the brain carries a risk of premature ovarian insufficiency (POI) if scatter radiation reaches the ovaries, though this is uncommon with cranial rather than pelvic radiation. POI is defined as loss of normal ovarian function before age 40, confirmed by two FSH measurements >25 IU/L taken at least four weeks apart. Women with POI have a substantially higher risk of early osteoporosis and cardiovascular disease and require hormone replacement therapy until at least the age of natural menopause (approximately 51).

Hormone Replacement After HPG Axis Disruption

If pituitary gonadotropin deficiency is confirmed after intracranial surgery, a woman may require exogenous sex hormones to maintain estrogen levels adequate for bone density, cardiovascular health, and quality of life. This is different from menopause hormone therapy (MHT) in that the cause is central (pituitary or hypothalamic failure) rather than gonadal (ovarian aging). Treatment is typically with combined estrogen-progestogen therapy and is managed by a reproductive endocrinologist or endocrinologist with pituitary expertise.

Does Maria Menounos Take Fertility Medication?

This is one of the most frequently searched questions about Maria Menounos, and the honest answer is: she has not publicly disclosed this. The clinical context matters.

If Maria used her own eggs for the IVF cycle that produced Athena, she would have taken gonadotropin injections during that retrieval cycle. Standard ovarian stimulation medications include follitropin alfa (Gonal-F) or follitropin beta (Follistim), sometimes combined with a GnRH antagonist such as cetrorelix or ganirelix to prevent premature ovulation. The trigger shot is typically human chorionic gonadotropin (hCG, brand names Pregnyl, Ovidrel) or a GnRH agonist such as leuprolide.

These medications are taken for a discrete window of approximately two weeks. They are not ongoing medications. After the retrieval cycle, the intended mother has no further pharmacological role in a gestational surrogacy arrangement unless she elects a subsequent retrieval.

If Maria has any residual pituitary dysfunction from her tumor or its treatment, she might take ongoing hormone replacement. But this is inference, not confirmed information. No published interview or podcast transcript as of early 2025 details ongoing medication use.

Fertility After Serious Illness: What This Means for You

Maria Menounos's story is one data point in a much larger picture: women who face serious medical diagnoses during their reproductive years and must make fertility decisions under time pressure, incomplete information, and emotional weight.

Reproductive Years (Under 35)

If you receive a diagnosis of a serious illness before age 35, time and ovarian reserve are generally on your side. Fertility preservation via embryo or oocyte freezing is most effective at younger ages. A single egg retrieval cycle at age 30-34 yields a median of 10-15 mature oocytes, compared to 5-8 at age 38-40, making preservation more efficient and giving you more options later.

Trying to Conceive After Illness (35-42)

This is roughly the life stage Maria was navigating. Options include attempting natural conception if ovarian and uterine function are intact, using frozen embryos from a prior preservation cycle, pursuing a fresh IVF cycle, or using donor eggs if ovarian reserve is significantly diminished. Gestational surrogacy is added to the list when uterine carrying is contraindicated or medically inadvisable.

Perimenopause (Typically 45-55)

Women who experienced fertility-affecting illness in their 30s or early 40s may arrive at perimenopause earlier than expected, particularly if they experienced radiation-induced pituitary damage or POI. The transition may also be harder to read, because symptoms such as hot flashes, cycle irregularity, and brain fog overlap with the sequelae of illness and its treatment. A reproductive endocrinologist or NAMS-certified menopause practitioner can help you distinguish between them.

Who This Story Is Clinically Relevant For

Maria's journey is most directly relevant for women who:

• Have received a diagnosis of a brain tumor, pituitary tumor, or any intracranial lesion during their reproductive years
• Are about to undergo surgery, radiation, or chemotherapy and have not yet discussed fertility preservation with their care team
• Are considering or pursuing gestational surrogacy and want a clear clinical picture of what the process involves for the intended mother
• Have experienced unexplained menstrual irregularity after a serious illness or intracranial procedure
• Are navigating family-building decisions at ages 38 or older with a complex medical history

Women in these situations should work with a reproductive endocrinologist (REI) with experience in oncofertility or complex medical histories. The Society for Assisted Reproductive Technology's clinic finder and ASRM's patient resources are practical starting points.

Pregnancy and Lactation Considerations for Women Who Have Had a Brain Tumor

This section addresses a question that is clinically important and often inadequately discussed: can a woman who has had a meningioma safely carry a pregnancy herself, and can she breastfeed?

Pregnancy After Meningioma

Meningiomas express progesterone and estrogen receptors. Pregnancy, which dramatically elevates both hormones, has been associated with accelerated meningioma growth. Case series and retrospective data suggest that meningioma growth during pregnancy is a recognized phenomenon, though the absolute risk of symptomatic tumor growth in any individual pregnancy is not well quantified. For this reason, many neurosurgeons and REIs counsel women with a history of meningioma that pregnancy carries a monitoring obligation and possibly an increased risk of recurrence or symptom exacerbation.

This is a primary reason why some women with meningioma history elect surrogacy rather than attempting to carry a pregnancy themselves. The decision is not always about uterine function; it may be about the risk of exposing a hormone-sensitive tumor to the hormonal environment of pregnancy.

Breastfeeding

Maria Menounos did not carry her daughter, so the lactation question does not apply directly to her experience. For women with meningioma history who do carry pregnancies, breastfeeding is generally not contraindicated on the basis of the tumor alone, but the hormonal and sleep deprivation demands of lactation should be discussed with the neurosurgical team.

Contraception for Women With Meningioma History

Because meningiomas express sex-hormone receptors, the use of combined hormonal contraceptives (estrogen-progestogen pills, patches, rings) after a meningioma diagnosis is an area of active clinical debate. Some retrospective studies have found an association between long-term progestogen-only contraceptive use and meningioma risk, leading some centers to advise against progestogen-dominant methods in women with meningioma history. Barrier methods or a copper IUD may be preferred in women who need ongoing contraception after meningioma treatment, pending guidance from the treating neurosurgeon and gynecologist.

Evidence Gaps: What We Do Not Know

Women with meningioma, particularly younger women of reproductive age, have been understudied in fertility outcomes research. The majority of what we know about fertility after intracranial surgery comes from pituitary adenoma literature, which may not generalize perfectly to meningioma. A 2021 review in the Journal of Clinical Endocrinology and Metabolism called attention to the lack of prospective fertility outcome data in women treated for non-pituitary intracranial tumors, a genuine gap in women's health research.

Maria Menounos has chosen to share her journey publicly and has done so in a way that is candid about the emotional dimensions while remaining appropriately private about clinical specifics. That combination is actually useful: it draws women's attention to a set of reproductive medicine questions many would not otherwise encounter until a diagnosis forces the issue.

If you are a woman who has been diagnosed with any intracranial lesion, ask your neurologist or neurosurgeon directly: "How might this diagnosis or its treatment affect my fertility and my menstrual cycle?" If you do not receive a satisfying answer, ask for a referral to a reproductive endocrinologist. ASRM's oncofertility resources and ASCO's fertility preservation guidelines are the clinical standards against which your care should be measured.