Document:

AMENDMENT NO. 9 TO SERVICE AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

                       FERTILITY CENTERS OF ILLINOIS, S.C.

         THIS AMENDMENT NO. 9 TO SERVICE AGREEMENT ("Amendment No. 9"), dated
December ___, 2003 by and between IntegraMed America, Inc., a Delaware
corporation, with its principal place of business at Two Manhattanville Road,
Purchase, New York 10577 ("INMD") and Fertility Centers of Illinois, an Illinois
Medical Service corporation, with a place of business at 3703 West Lake Avenue,
Suite 310, Glenview, Illinois corporation, ("PC").

                                    RECITALS:

         WHEREAS, INMD and PC are parties to a Service Agreement dated February
28, 1997, as amended (the "Agreement");and

         WHEREAS, INMD and PC wish to amend further the Agreement, in pertinent
part to clarify certain financial and other terms and conditions;

         NOW THEREFORE, in consideration of the mutual promises and covenants
herein contained, and as contained in the Agreement, as amended, INMD and PC
agree as follows:

1. Section 6.1.4 of the Agreement is hereby deleted in its entirety and the
following substituted therefor:

            "6.1.4 effective January 1, 2004, during each year of this
            Agreement, an Additional Service Fee, paid monthly but
            reconciled quarterly, in accordance with the following table:

            Applicable Year           Additional Service Fee
            ---------------           ----------------------

            2004                      12% of Revenue, not to exceed16% of PDE
            2005                      12% of Revenue, not to exceed 12% of PDE
            2006                      12% of Revenue, not to exceed 8 % of PDE
            2007 and thereafter       12% of Revenue, not to exceed 10% of PDE

            Notwithstanding  anything  in this  Section  6.1.4 to the  contrary,
beginning  January 1, 2007,  the minimum annual  Additional  Service Fee paid to
IntegraMed  under this Agreement shall not be less than $932,484 per year but in
no event shall exceed 20% of PDE, and the maximum annual Additional  Service Fee
paid to IntegraMed shall not exceed $1,865,000."

2. All other provisions of the Agreement, as amended, not in conflict with this
Amendment No. 9 remain in full force and effect.

         IN WITNESS WHEREOF, the parties have signed this Amendment No. 9 as the
date first written above.

INTEGRAMED AMERICA, INC.

By:  /s/Gerardo Canet
     -------------------------------------
        Gerardo Canet, President

FERTILITY CENTERS OF ILLINOIS, S.C.

By:  /s/Aaron S. Lifchez
     ------------------------------------
        Aaron S. Lifchez, M.D., President-

                      AMENDMENT NO. 7 TO SERVICE AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

                  SHADY GROVE REPRODUCTIVE SCIENCE CENTER, P.C.

         THIS AMENDMENT NO. 7 TO SERVICE AGREEMENT ("Amendment No. 7") is dated
November ___, 2003 by and between IntegraMed America, Inc., a Delaware
corporation, with its principal place of business at Two Manhattanville Road,
Purchase, New York 10577 ("INMD") and Shady Grove Reproductive Science Center,
P.C., a Maryland professional corporation, with its principal place of business
at 15001 Shady Grove Road, Suite 310, Rockville, Maryland 20850 ("PC").

                                    RECITALS:

         WHEREAS, INMD and PC are parties to a Service Agreement dated March 12,
1998, as amended (the "Agreement");and

         WHEREAS, INMD and PC wish to amend further the Agreement, in pertinent
part to clarify certain financial and other terms and conditions;

         NOW THEREFORE, in consideration of the mutual promises and covenants
herein contained, and as contained in the Agreement, as amended, INMD and PC
agree as follows:

1. Section 7.1.4 of the Agreement, as amended to date, is hereby deleted in its
entirety and the following substituted therefor:

                  "7.1.4 Effective as of January 1, 2004, during each year of
                  this Agreement, an Additional Service Fee, paid monthly but
                  reconciled quarterly, in accordance with the following table:

  Applicable Year      Additional Service Fee   Maximum Additional Service Fee

  2004                         16% of PDE                    None
  2005                         14% of PDE                    None
  2006                         10% of PDE                    $1,000,000.00
  2007                         10% of PDE                    $  900,000.00
  2008                         10% of PDE                    $  800,000.00
  2009 and thereafter          10% of PDE                    $1,080,000.00

                  Notwithstanding anything in this Section 7.1.4 to the
contrary, beginning January 1, 2006, the minimum annual Additional Service Fee
paid to IntegraMed under this Agreement shall not be less than $540,000 per
year, and the maximum annual Additional Service Fee paid to IntegraMed shall not
exceed the amounts set forth above for the indicated years; but in no event
shall the annual Additional Service Fee exceed 20% of PDE.

2. All other provisions of the Agreement, as amended, not in conflict with this
Amendment No. 7 remain in full force and effect.

         IN WITNESS WHEREOF, the parties have signed this Amendment No.7 as the
date first written above.

INTEGRAMED AMERICA, INC.

By:  /s/Gerardo Canet
     --------------------------
        Gerardo Canet, President

SHADY GROVE REPRODUCTIVE SCIENCE CENTER, P.C.

By:  /s/Michael J. Levy
     ---------------------------
        Michael J. Levy, M.D., PresidentTHIRD AMENDMENT AND WAIVER TO
                       AMENDED AND RESTATED LOAN AGREEMENT

         Third Amendment and Waiver (this "Amendment") entered into as of
November 14, 2003 between INTEGRAMED AMERICA, INC. (the "Borrower") and FLEET
NATIONAL BANK (the "Bank").

         WHEREAS, the Borrower and the Bank are parties to an Amended and
Restated Loan Agreement dated as of September 28, 2001, as amended by a First
Amendment thereto dated as of September 16, 2002 and a Second Amendment dated as
of July 31, 2003 (as so amended, the "Agreement"); and

         WHEREAS, the Borrower has requested that the Bank amend and waive, and
the Bank has agreed to amend and waive, certain provisions of the Agreement.

         NOW, THEREFORE, the parties hereto hereby agree as follows:

1. All capitalized terms used herein, unless otherwise defined herein, have the
same meanings provided therefor in the Agreement.

2. The Agreement is hereby amended as follows:

     (a) The following definitions set forth in Section 1.1 of the Agreement are
amended to read in their entirety as follows:

                  "Acquisition" shall mean the acquisition by purchase or
         otherwise of (i) the business or assets of or Capital Stock of another
         Person and/or (ii) of the right to manage and/or service certain
         aspects of the business of a Practice Group, whether pursuant to a
         Management Agreement or otherwise.

                  "Permitted Acquisition" shall mean any Acquisition that
         satisfies each of the following conditions: (i) the entire business or
         assets acquired or business of the entity whose Capital Stock is
         acquired shall be substantially similar to the Borrower's line of
         business as conducted on the date of this Agreement; (ii) (a) the
         Acquisition Cost with respect to any one Acquisition shall not exceed
         $1,000,000 and (b) the Acquisition Cost with respect to all
         Acquisitions in any one calendar year shall not exceed $3,000,000;
         (iii) neither the Borrower nor such acquiree has incurred any
         additional Indebtedness to finance, or otherwise in connection with,
         such Acquisition, whether in the form of seller notes, third party
         Indebtedness or otherwise to the extent same would cause the
         Acquisition Cost to exceed the limitations set forth in "(ii)" of this
         definition; (iv) if the Acquisition is of the Capital Stock of another
         Person, said Acquisition shall either be of all of such Capital Stock
         or shall be structured by merger, consolidation or otherwise; (v) at
         the time of such Acquisition no Default or Event of Default exists and
         no Default or Event of Default would occur after giving effect to such
         Acquisition; (vi) the Borrower shall have delivered to the Bank, not
         less than 10 days prior to the consummation of such Acquisition, (A) a

<PAGE>

         certificate of a financial officer of the Borrower, in all respects
         reasonably satisfactory to the Bank and dated the date of such
         consummation, attaching a pro-forma compliance certificate (in a format
         satisfactory to the Bank) evidencing compliance with Section 6 of this
         Agreement (subsections 6(a), 6(b), 6(c), 6(d) and 6(e) of this
         Agreement; as the same may be amended from time to time) after giving
         effect to such Acquisition and based on the most recent financial
         statements delivered to the Bank pursuant to this Agreement; provided,
         that, as to such financial covenants (and any other financial covenants
         now or hereafter applying to the facilities described in this
         Agreement), all of such covenants shall be deemed amended to require
         compliance as to the Borrower with the entity acquired in the
         Acquisition, (B) copies of the purchase or merger agreement or any
         other material documents executed in connection with the Acquisition,
         (C) if the Acquisition is an Acquisition of the Capital Stock of a
         Person, (w) copies of the resolutions of the of the Board of Directors
         (or similar governing body) of such new Subsidiary authorizing the
         execution, delivery and performance of its respective Guarantee,
         security agreement and other Loan Documents to which it is a party,
         certified respectively by an authorized officer of such new Subsidiary,
         (x) a certificate of an authorized officer of such new Subsidiary
         certifying the names and true signatures of the officers of new
         Subsidiary to sign any and all documents to be delivered by new
         Subsidiary or as required or contemplated hereunder, (y) the
         organizational documents of such new Subsidiary, all of which shall be
         in form and substance satisfactory to the Bank and certified as true
         and correct by an authorized officer of such new Subsidiary and (z) a
         good standing certificate as of the dates not more than twenty (20)
         days prior to the date of delivery thereof to the Bank from the
         Secretary of State of the respective state of organization of such new
         Subsidiary and each state in which it is qualified to do business, (D)
         if the Acquisition is of the right to manage and/or service certain
         aspects of the business of a Practice Group, each such applicable
         Practice Group shall have executed and delivered to the Bank a security
         agreement, in form and substance substantially similar to those
         delivered by the Practice Groups in connection with the Second
         Amendment and the Bank shall have received an opinion of counsel to the
         Borrower, in form and substance substantially similar to that delivered
         in connection with the Second Amendment, with respect to each such
         Practice Group's security agreement and (E) satisfactory Uniform
         Commercial Code and other searches with respect to the acquiree and/or
         applicable Practice Group; (vii) the Acquisition shall have the
         approval of the target company's board of directors (or similar
         governing body); (viii) the Bank shall have filed all applicable
         Uniform Commercial Code financing statements and shall have received
         such other information or documents as it shall have reasonably
         requested in connection with such Acquisition; (ix) the Acquisition
         shall have been consummated in accordance with the definitive
         acquisition agreement, without any waiver or amendment of any material
         term or condition therein not consented to by the Bank and in
         compliance with all applicable laws and all necessary approvals, except
         where the failure to so comply could not reasonably be expected to have
         a material adverse effect on the acquiree or on the Borrower; (x) the
         Borrower shall have complied with any applicable state takeover law and
         any applicable supermajority charter provisions and (xi) all
         governmental and third-party consents and approvals necessary in
         connection with each aspect of the Acquisition shall have been obtained
         (without the imposition of any unreasonable conditions) and shall
         remain in effect, except where the failure to obtain same could not
         reasonably be expected to have a material adverse effect on the
         acquiree or on the Borrower; all applicable waiting periods shall have
         expired or been terminated or waived without any material adverse
         action being taken by any authority having jurisdiction; and no law or
         regulation shall be applicable that restrains, prevents or imposes
         material adverse conditions upon any aspect of the Acquisition.

     (b) Section 7.2 of the  Agreement  is amended by  replacing  the phrase "or
acquire by purchase or otherwise the business or assets of, or stock of, another
business  entity"  with the  phrase "or make any  Acquisition  or enter into any
Management Agreement".

<PAGE>

     (c) Section  7.3(iv) of the Agreement is amended to read in its entirety as
follows:

         (iv) purchases of accounts receivable pursuant to Management Agreements
         to which the Borrower or any Subsidiary is party; provided such
         Management Agreement exists as of the date hereof or is entered into in
         connection with a Permitted Acquisition,

     (d)  Section  7.9 of the  Agreement  is amended to read in its  entirety as
follows:

                  7.9      [Intentionally Omitted.]

     (e)  Section  9.2 of the  Agreement  is amended to read in its  entirety as
follows:

                  9.2 Additional Collateral Security. In addition to the
         collateral described in Section 9.1 hereof, payment of the Obligations
         is also secured by a first priority (subject to Liens permitted by this
         Agreement) security interest in (i) all assets and personal property
         and fixtures of the Borrower and each Guarantor, (ii) assignments of
         all financing statements in favor of the Borrower and/or the Guarantors
         in connection with its (their) purchase of accounts receivable, (iii)
         all accounts receivable of each Practice Group (to the extent same are
         subject to any purchase agreement between such Practice Group, as
         seller, and the Borrower, as purchaser), (iv) all the issued and
         outstanding Capital Stock of each Subsidiary that is or becomes a
         Guarantor, and (v) all proceeds and products of the forgoing, whether
         now owned or hereafter acquired, as provided in a Security Agreement
         executed or to be executed and delivered by the Borrower and each
         Guarantor to the Bank.

3. Pursuant to the Agreement, the Borrower is not permitted to enter into any
Acquisition other than Permitted Acquisitions and the Borrower acquired certain
assets of Reproductive Endocrine Associates of Charlotte, P.C. in a transaction
that was not a Permitted Acquisition. The Bank hereby agrees to waive compliance
with the Agreement, but solely with respect to the Borrower's Acquisition of
certain assets of Reproductive Endocrine Associates of Charlotte, P.C. and its
entering into a Management Agreement with Reproductive Endocrine Associates of
Charlotte, P.C. and such transaction shall be deemed a Permitted Acquisition for
purposes of the Agreement.

4. The Borrower hereby represents and warrants to the Bank that:

     (a) Each and every of the  representations  and warranties set forth in the
Agreement  and/or the  documents  executed  pursuant  thereto  or in  connection
therewith  is true as of the date hereof and with the same effect as though made
on the date hereof, and is hereby incorporated herein in full by reference as if
fully restated herein in its entirety.

     (b) No Default or Event of Default and no event or  condition  which,  with
the giving of notice or lapse of time or both,  would  constitute such a Default
or Event of  Default,  now exists or would  exist,  except  those that are being
waived pursuant to this Amendment.

<PAGE>

5. All obligations in connection with the Agreement are and shall continue to be
(i) secured by the collateral referenced in the Agreement and more fully
described in one or more security agreements in favor of the Bank and (ii)
guaranteed by the Guarantors referenced in the Agreement pursuant to Guarantees
in favor of the Bank.

6. By their execution of this Amendment in the space provided below, each of the
guarantors indicated below hereby consent to this Amendment and reaffirm their
continuing liability under their respective guarantees, in respect of the
Agreement as amended hereby and all the documents, instruments and agreements
executed pursuant thereto or in connection therewith, without offset, defense or
counterclaim (any such offset, defense or counterclaim as may exist being hereby
irrevocably waived by such guarantors).

7. The waiver provided in this Amendment is effective only in this one instance
and only with respect to the Borrower's Acquisition of certain assets of
Reproductive Endocrine Associates of Charlotte, P.C. and its entering into a
Management Agreement with Reproductive Endocrine Associates of Charlotte, P.C..
Furthermore, the amendments and waiver set forth herein are limited precisely as
written and shall not be deemed to (a) be a consent to or a waiver of any other
term or condition of the Agreement or any of the documents referred to therein
or (b) prejudice any right or rights which the Bank may now have or may have in
the future under or in connection with the Agreement or any documents referred
to therein. Whenever the Agreement is referred to in the Agreement or any of the
instruments, agreements or other documents or papers executed and delivered in
connection therewith, it shall be deemed to mean the Agreement as modified by
this Amendment.

8. This Amendment shall be effective as of the date first above written;
provided that this Amendment shall not be effective unless and until the Bank
shall have received counterparts of this Amendment duly signed by the Borrower
and the guarantors indicated below.

9. This Amendment may be executed by the parties hereto individually or in any
combination, in one or more counterparts, each of which shall be an original and
all of which shall together constitute one and the same agreement.

                   [Balance of page intentionally left blank]

<PAGE>

         IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
duly executed and delivered by their respective duly authorized officers as of
the date first above written.

                                    INTEGRAMED AMERICA, INC.

                                    By:/s/John W. Hlywak, Jr.
                                        -----------------------------
                                    Name: John W. Hlywak, Jr.
                                    Title: Senior Vice President and
                                           Chief Financial Officer

                                    FLEET NATIONAL BANK

                                    By: /s/Thomas G. Carley
                                        -----------------------------
                                    Name:  Thomas G. Carley
                                    Title:    Senior Vice President

         Each of the guarantors indicated below hereby consent to this Amendment
and reaffirm their continuing liability under their respective guarantees in
respect of the Agreement as amended hereby and all the documents, instruments
and agreements executed pursuant thereto or in connection therewith, without
offset, defense or counterclaim (any such offset, defense or counterclaim as may
exist being hereby irrevocably waived by such guarantors).

                                    INTEGRAMED PHARMACEUTICAL SERVICES, INC.

                                    By:  /s/John W. Hlywak, Jr.
                                        -----------------------------
                                    Name:   John W. Hlywak, Jr.
                                    Title:  Vice President

                                    INTEGRAMED FINANCIAL SERVICES, INC.

                                    By:  /s/John W. Hlywak, Jr.
                                        -----------------------------
                                    Name:   John W. Hlywak, Jr.
                                    Title:  Vice President

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