Document:

AMENDMENT NO. 3 TO MANAGEMENT AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

              BAY AREA FERTILITY AND GYNECOLOGY MEDICAL GROUP, INC.

         THIS AMENDMENT NO. 3 TO MANAGEMENT AGREEMENT ("Amendment No. 3"), dated
April 1, 2000 by and between IntegraMed America,  Inc., a Delaware  corporation,
with its principal place of business at One Manhattanville Road,  Purchase,  New
York 10577 ("INMD") and Bay Area Fertility and Gynecology Medical Group, Inc., a
California  professional  medical  corporation,  with  its  principal  place  of
business  at 3160 Crow  Canyon  Road,  Suite 150,  San Ramon,  California  94583
("PC").

                                    RECITALS:

         WHEREAS,  INMD and PC entered into a Management Agreement dated January
7, 1997, as amended (the "Management Agreement");and

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

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

         1.

                  Section   2.1.2  is  hereby   deleted  and  the  following  is
substituted therefor, effective April 1, 2000:

                  "2.1.2.  Expenses  incurred in the  recruitment  of additional
                  physicians for P.C.  including,  but not limited to employment
                  agency fees, travel expenses and relocation expenses;  and, up
                  to  $175,000  for the first 12 months of each new  physician's
                  employment [for purposes of this section "new physician" shall
                  mean a physician  starting a practice and is without a patient
                  referral base] to cover such costs as a signing bonus, if any,
                  and  salary;  provided,  however,  any  such  amount  must  be
                  approved  by  the  Joint  Practice   Management   Board  on  a
                  case-by-case   basis;  and  provided,   further,   "additional
                  physician"  shall mean a new physician  whose hiring is not to
                  replace a physician  who has left P.C.  within 12 months prior
                  to the  employment  of the new  physician,  but  whose  hiring
                  increases PC's full-time  equivalent  ("FTE")  physicians to a
                  number  greater than PC's FTE  physicians  for the previous 12
                  months;"

<PAGE>

         2.       Section  6.1.2  is  hereby  deleted  in its  entirety  and the
following substituted therefor, effective April 1, 2000:

                  "6.1.2 during each year of this  Agreement,  a Base Management
                  Fee, paid  monthly,  of an amount equal to six percent (6%) of
                  the first $8.0 million of P.C.'s  Revenues;  five percent (5%)
                  of P.C.'s  Revenues over $8.0, but less than $12 million;  and
                  four percent (4%) of P.C's Revenues of $12 million and above."

         3.       Section  6.1.4  is  hereby  deleted  in its  entirety  and the
following substituted therefor, effective April 1, 2000:

                  "6.1.4  during  years  6  through  25 of  this  Agreement,  an
                  Additional   Management   Fee,  paid  monthly  but  reconciled
                  quarterly,  in an amount  equal to  fifteen  (15%)  percent of
                  Revenues, but not to exceed 20% of PDE."

            4.    All other provisions of the Management Agreement,  as amended,
not in conflict with this Amendment No. 3 remain in full force and effect.

         IN WITNESS WHEREOF, the parties have signed this Amendment No. 3 as the
date first written above.

INTEGRAMED AMERICA, INC.

By:/s/Donald S. Wood, Ph.D.
   ----------------------------------------------
   Donald S. Wood, Ph.D.,
   Sr. Vice President and Chief Operating Officer

BAY AREA FERTILITY AND GYNECOLOGY MEDICAL GROUP, INC.

By:/s/Arnold Jacobson, M.D., President
   -----------------------------------
   Arnold Jacobson, M.D., PresidentAMENDMENT NO. 7 TO MANAGEMENT AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

                       FERTILITY CENTERS OF ILLINOIS, S.C.

         THIS AMENDMENT NO. 7  TO MANAGEMENT AGREEMENT ("Amendment No. 7")
is dated as of April 1, 2000 by and between IntegraMed America, Inc., a Delaware
corporation,  with its principal place of business at One  Manhattanville  Road,
Purchase,  New York 10577 ("INMD") and Fertility  Centers of Illinois,  S.C., an
Illinois medical corporation, with its principal place of business at 3000 North
Halsted Street, Suite 509, Chicago, Illinois 69657 ("FCI").

                                    RECITALS:

         INMD and FCI entered into a  management  agreement  dated  February 28,
1997,  as amended,  with an effective  date of August 19, 1997 (the  "Management
Agreement");

         INMD and FCI  desire  to amend  further  certain  financial  terms  and
conditions of the Management Agreement governing their relationship.

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

         1.       Section   2.1.2  is  hereby   deleted  and  the  following  is
substituted therefor, effective January 1, 2000:

                  "2.1.2 Expenses incurred in recruiting  additional  physicians
                  for FCI, including, but not limited to employment agency fees,
                  travel expenses and relocation  costs; and, up to $175,000 for
                  the  first 12  months of each new  physician's  employment  to
                  cover  such  costs as a signing  bonus,  if any,  and  salary;
                  provided,  however,  any such  amount  must be approved by the
                  Joint Practice  Management Board on a case-by-case basis prior
                  to  being  incurred;   and  provided,   further,   "additional
                  physician"  shall mean a new physician  whose hiring is not to
                  replace a physician  who has left P.C.  within 12 months prior
                  to the  employment  of the new  physician,  but  whose  hiring
                  increases PC's full-time  equivalent  ("FTE")  physicians to a
                  number  greater than PC's FTE  physicians  for the previous 12
                  months;"

<PAGE>

         2.       Section 6.1.4 of the Management Agreement is hereby deleted in
its entirety and the following is hereby substituted therefor, effective January
1, 2000:

                  "6.1.4  during  each  year of this  Agreement,  an  Additional
                  Management  Fee,  paid monthly but  reconciled  quarterly,  in
                  accordance with the following  table; and provided further the
                  Additional  Management  Fee  shall  not  exceed  20% of  FCI's
                  Physician  and Other  Revenues  less Cost of Services  and the
                  Base Management Fee for any Fiscal Year:

                  Cost of Services plus the Base
                  Management Fee as a % of Revenues    Additional Management Fee
                  ---------------------------------    -------------------------

                        50% and Below                    10 1/2% of Revenues
                        51% to 60%                        9 1/2% of Revenues
                        61% to or more                    8 1/2% of Revenues

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

         4.       This  Amendment No.7 may be executed in any number of separate
counterparts,  each of which shall be deemed to be an original, but all of which
together shall constitute one and the same instrument.

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

INTEGRAMED AMERICA, INC.

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

FERTILITY CENTERS OF ILLINOIS, S.C.

By:/s/Aaron S. Lifchez
   ----------------------------
   Aaron S. Lifchez, PresidentAMENDMENT NO. 4 TO MANAGEMENT AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

                  SHADY GROVE REPRODUCTIVE SCIENCE CENTER, P.C.

         THIS AMENDMENT NO. 4 TO MANAGEMENT AGREEMENT ("Amendment No. 4"), dated
April 1, 2000 by and between IntegraMed America,  Inc., a Delaware  corporation,
with its principal place of business at One 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 Management Agreement dated March
12, 1998, as amended (the "Management Agreement");and

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

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

         1.      Section   2.1.2  is  hereby   deleted  and  the  following  is
substituted therefor, effective April 1, 2000:

                  "2.1.2.  Expenses  incurred in the  recruitment  of additional
                  physicians for P.C.  including,  but not limited to employment
                  agency fees, travel expenses and relocation expenses;  and, up
                  to  $175,000  for the first 12 months of each new  physician's
                  employment to cover such costs as a signing bonus, if any, and
                  salary; provided, however, any such amount must be approved by
                  the Joint Practice  Management Board on a case-by-case  basis;
                  and provided, further, "additional physician" shall mean a new
                  physician  whose hiring is not to replace a physician  who has
                  left P.C.  within 12 months prior to the employment of the new
                  physician,   but  whose  hiring   increases   PC's   full-time
                  equivalent  ("FTE")  physicians to a number  greater than PC's
                  FTE physicians for the previous 12 months;"

<PAGE>

         2.       Section  7.1.3  is  hereby  deleted  in its  entirety  and the
following substituted therefor, effective April 1, 2000:

                  "7.1.3 during each year of this  Agreement,  a Base Management
                  Fee, paid  monthly,  of an amount equal to six percent (6%) of
                  the first $8.0 million of P.C.'s  Revenues;  five percent (5%)
                  of P.C.'s  Revenues over $8.0, but less than $12 million;  and
                  four percent (4%) of P.C's Revenues of $12 million and above."

         3.       Section  7.1.4  is  hereby  deleted  in its  entirety  and the
following substituted therefor, effective April 1, 2000:

                  "7.1.4  during  each  year of this  Agreement,  an  Additional
                  Management  Fee,  paid monthly but  reconciled  quarterly,  in
                  accordance with the following  table; and provided further the
                  Additional  Management  Fee shall not  exceed  the  applicable
                  percent of PC's PDE for any Fiscal Year:

                  Cost of Services plus the Base
                  Management Fee as a % of Revenues    Additional Management Fee
                  ---------------------------------    -------------------------

                         Below 76%                           20% of PDE
                         76% to 81%                          17.5% of PDE
                         81% or more                         15% of PDE

            4.    All other provisions of the Management Agreement,  as amended,
not in conflict with this Amendment No. 4 remain in full force and effect.

         IN WITNESS WHEREOF, the parties have signed this Amendment No. 4 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, M.D.
   --------------------------------
   Michael J. Levy, M.D., President

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