Do Surrogates Get Paid More for Twins? | Worldwide Surrogacy

How much more a surrogate is paid for carrying twins

Base compensation is $65,000 to $75,000 for a first-time surrogate, paid in monthly installments across the pregnancy that begin once a heartbeat is confirmed. With additional payments, total compensation reaches up to $95,000, or more depending on your experience. Expenses are reimbursed separately, on top of both.

Your base compensation is set in your Gestational Surrogacy Agreement, and what you are paid can vary with your experience, the state you live in, whether you carry multiples and your medical history. These are the payments on the published schedule that matter most with twins:

$10,000 is paid if you are carrying more than one baby, whether that is twins or more, with a further $500 listed alongside the embryo transfer fee.
$5,000 is added if the babies are delivered by cesarean.
$150 a week for housekeeping is paid where your doctor recommends bed rest.
$150 for each 24-hour period of childcare is paid on the same basis.
Your lost wages are covered for the periods set out in your agreement, and your spouse's where your agreement provides for them.

Carrying twins does not change your base compensation. Base is requested and agreed before the contract phase, before anyone knows whether it is one baby or two, so what twins add is the multiples fee rather than a higher base.

The rest of the schedule, and when each payment is made, is on when and how surrogates are paid. The figures as published are on surrogate compensation and benefits.

Is a twin pregnancy riskier for a surrogate?

Yes. The American College of Obstetricians and Gynecologists (ACOG) names preterm birth as the most common complication of a multiple pregnancy. It also notes that preeclampsia occurs more often in multiple pregnancies and tends to start earlier, that carrying multiples brings a high risk of gestational diabetes, and that twins who share a placenta have a higher risk of complications than twins with separate placentas (ACOG, Multiple Pregnancy).

What those risks mean for you depends on your own health and on the kind of twin pregnancy it is, so ask your obstetrician and the IVF physician directly.

Who pays for the extra care a twin pregnancy needs

ACOG notes that with multiples you are likely to have more frequent prenatal visits and, from the second trimester, may have ultrasound exams every four to six weeks, or more often if a problem is suspected. The intended parents pay the medical expenses of the pregnancy, including that extra care, and they pay for your health insurance. If your own policy does not cover surrogacy, one is provided at no cost to you.

Why twins are more likely to be delivered by cesarean

ACOG notes that the chance of a cesarean birth is higher with multiples, and that some twins are delivered vaginally. How the babies are born depends on the number of babies, the position, weight and health of each baby, your own health, how labor is going and the experience of your obstetrician. Whether to consent to a cesarean is your decision, made with your obstetrician. If the babies are delivered by cesarean, the schedule carries a $5,000 payment.

How early twins are usually born

In 2024, 61% of twins born in the United States arrived before 37 weeks of pregnancy, compared with fewer than 9% of single babies (CDC, Births: Final Data for 2024). Even when a twin pregnancy is uncomplicated, ACOG and the Society for Maternal-Fetal Medicine suggest delivery at 38 weeks for twins with separate placentas, and from 34 weeks through the end of week 37 for twins who share a placenta but have separate sacs (ACOG Committee Opinion 831).

Base compensation is paid in monthly installments across the pregnancy, beginning when a blood test confirms the pregnancy, and the published schedule pays the final installment after the birth, along with the multiples and cesarean payments. Because twins often arrive early, installments can still be outstanding at delivery.

What bed rest pays, if your doctor recommends it

Whether you need bed rest is something to decide with your own doctor. If it is recommended, the schedule reimburses housekeeping at $150 a week and childcare at $150 for each 24-hour period of care. Lost wages are reimbursed for the periods set out in your agreement.

How time off work is paid in a twin pregnancy

A twin pregnancy can mean more time away from work: more appointments, any bed rest your doctor recommends, and recovery after the birth. Lost wages are reimbursed for the periods set out in your agreement, and your spouse's where they apply. Your own independent attorney, whom you choose and the intended parents pay for, reviews the agreement and the compensation terms with you, and is the person to ask how the lost wages periods would apply if you carry twins.

Lost wages cover lost time as well as lost pay. If you use a paid time off day for an appointment, it is reimbursed at your gross daily wage rather than treated as a day you were paid for anyway.

Who decides how many embryos are transferred?

No embryo is transferred without your consent, so no one can transfer more embryos than you agree to. You have complete bodily autonomy, including whether to consent to a cesarean and which medical providers you use. Your Gestational Surrogacy Agreement memorializes those rights, and you always keep the right to make medical decisions for yourself while you are pregnant.

Professional guidance is relevant here, though it is guidance rather than our rule. The American Society for Reproductive Medicine (ASRM) strongly recommends transferring a single embryo in every gestational carrier cycle, because of the health risks a multiple pregnancy carries for the person carrying it. Worldwide Surrogacy does allow intended parents to request a double embryo transfer, so this is a question you will be asked rather than one already settled, and no transfer happens without your consent. ASRM also lists intended parents' failure to follow its guidance on the number of embryos transferred, and inability to agree with the carrier's decision on the number of embryos transferred, among its criteria for rejecting intended parents (ASRM Practice Committee, 2022).

New York writes the right into statute. A person acting as surrogate there has "the right to make all health and welfare decisions regarding them-self and their pregnancy, including but not limited to whether to consent to a cesarean section or multiple embryo transfer" (N.Y. Fam. Ct. Act § 581-602).

The IVF physician can tell you what transferring one embryo or two would mean for your own pregnancy.

What happens if a twin pregnancy ends in a loss

If a twin pregnancy ends in a loss, what happens to your compensation and who pays for your medical care are on do surrogates get paid if they miscarry.