EXHIBIT 4.3(D)

                        PERSONAL RESPONSIBILITY AGREEMENT




         THIS PERSONAL RESPONSIBILITY AGREEMENT ("Agreement"),  dated January 7,
1997,  is made and  entered  into by and between  IntegraMed  America,  Inc.,  a
Delaware corporation, with its principal place of business at One Manhattanville
Road,  Purchase,  New York 10577  ("INMD"),  Bay Area  Fertility And  Gynecology
Medical  Group,  Inc., a California  professional  corporation  ("P.C."),  whose
principal  place of business is 5601 Norris  Canyon Road,  Suite 300, San Ramon,
California 94583, and Arnold Jacobson, M.D., whose mailing address is 2476 Alamo
Glen Drive, Danville, California 94526 ("Jacobson").


I. This Agreement is made with reference to a Management  Agreement of even date
herewith (the "Management  Agreement") between INMD and P.C., and with reference
to an Asset  Purchase  Agreement  of even date  herewith  (the  "Asset  Purchase
Agreement")  between INMD and Bay Area  Fertility  Medical  Group,  a California
professional partnership ("Partnership").

         A.  Jacobson  and Donald I. Galen,  M.D. and Louis N.  Weckstein,  M.D.
(collectively,  "Physicians")  are the sole shareholders of P.C., which owns all
of the  good  will of the  Partnership,  the  entity  through  which  Physicians
exclusively conducted their practice of medicine prior to the formation of P.C.

         B.  Pursuant  to  the  Management  Agreement  and  the  Asset  Purchase
Agreement,  INMD has transferred to the Physicians or entities  representing the
Physicians cash in excess of $1,500,000 and stock in INMD valued at $500,000.

         C. The services  Physicians  have offered  through the  Partnership and
intend to offer  through  P.C.  are  unique in terms of how these  services  are
rendered  and  the  relative  unavailability  of  similar  services  from  other
physicians,  and in terms of  Physicians'  reputation,  and involve both medical
professional  and technical  services.  Through  INMD's  resources,  the parties
intend to maintain and enhance the  technology  which  Physicians  offer through
P.C.

         D.  Physicians  intend  that P.C.  be the  entity  through  which  they
henceforth  conduct  their  practice  of  medicine,  and  have  entered  into an
Agreement Among Shareholders (the "Stock Purchase Agreement") and a Shareholders
Employment  Agreement  effective on or about January 7, 1997,  between and among
Physicians  and  P.C.  This  Agreement  is also  made  with  reference  to those
agreements,  which define Jacobson's and the other Physicians' respective rights
and responsibilities with respect to P.C. and their medical practices, including
but not limited to governance and compensation terms, a stock buy-sell agreement
and a covenant not to compete.



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         E. While it is the  objective of the parties to this  Agreement and the
above-referencedagreements  that the P.C.  expand its presence,  hire additional
and  replacement  physicians,  and otherwise seek to maintain and establish good
will apart from the continued full-time  commitment of each of Jacobson and each
of the other  Physicians,  the  parties  also  acknowledge  that at present  the
identity  of P.C.  is not  institutional,  but rather is  co-extensive  with the
individual practices of its current owners.

         F.  Jacobson  recognizes  that  the  success  of  P.C.  and  of  INMD's
investment in administrative and technologic resources depends on his commitment
and the  commitment  of each of the other  Physicians  to  continue  to practice
medicine exclusively through P.C. INMD has made substantial payments to Jacobson
and the other Physicians to assure their availability and dedication to P.C. and
has made and  plans to make a  substantial  investment  in  equipment  and other
resources for P.C. in reliance on the ability to amortize such investments based
on such assurances from Jacobson and each of the other Physicians.

         G. The purpose of this  Agreement  is to assure INMD that its  payments
and  commitment  of  resources is  supported  by the  commitment  of Jacobson to
exerting his best efforts to support the operation of P.C.  under its Management
Agreement  with INMD.  Jacobson  acknowledges  that each of the  Physicians  has
executed a similar agreement with INMD.

         Therefore, INMD, P.C., and Jacobson agree as follow:

         1. Term and Termination. This Agreement shall have the same term as the
Management Agreement.

         2.  P.C.  as   Representative   of   Jacobson's   Interests.   Jacobson
acknowledges that INMD is entering into the Management  Agreement with P.C. upon
Jacobson's  stipulation that P.C. represents his entire medical practice.  It is
agreed,  therefore,  that for purposes of assuring continuity of the commitments
under the Management  Agreement,  that P.C. is deemed the alter ego of Jacobson,
with specific rights and responsibilities existing between Jacobson and INMD, as
set forth herein. However, this Agreement shall not serve as evidence to justify
a claim by INMD that  Jacobson is liable on an alter ego theory for sums owed by
P.C. under Section 9.1 of the Management Agreement

         3. Repayment of Rateable Portion of Right to Manage Fee.

                  a. Pursuant to Article 7 of the Management Agreement, INMD has
paid P.C.,  for the benefit of  Physicians,  a Right to Manage Fee in the sum of
$1,000,000  cash and $500,000 in INMD stock and  pursuant to the Asset  Purchase
Agreement has paid to Partnership,  also for the benefit of Physicians,  the sum
of $500,000 for the name "Bay Area Fertility," said $2,000,000 being referred to
herein as the "Payment at Closing.". If, during the first five (5) years of this
Agreement,  Jacobson should cease to practice medicine through P.C., except as a
result of death or  disability,  Jacobson shall be obligated to forthwith pay to
INMD  one-third  of the  portion  of  the  Payment  at  Closing,  calculated  in
accordance with Section 9.1.3 of the Management  Agreement that would be payable
by P.C. if the Management Agreement terminated as of the date Jacobson ceased to
practice  medicine at P.C.'s  offices.  Said repayment  shall also be due in the
event of a reduction in Jacobson's  availability to provide the services that he
currently  provides,  e.g.,  if Jacobson  reduced his medical  office hours from
four-and-two-  thirds  days per week to  three-and-two-thirds  days per week the
additional multiplier would be twenty-one and four-tenths percent (21.4%), and


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if he increases his vacation from nine weeks per year to ten weeks per year, the
additional  multiplier would be eleven percent (11%), in each case multiplied by
the amount that would be paid had Jacobson  totally ceased work for P.C. at that
time.  Jacobson  may pay up to 25% of the sums due INMD under this  paragraph in
the form of INMD stock,  at its then fair market  value.  Payments to INMD under
this paragraph shall not entitle  Jacobson to any interest in the assets of P.C.
or INMD.

                  b.  The  parties   acknowledge   that   through  an  effective
transition  plan,  P.C.  may  add  another  physician  to its  practice  so that
Jacobson's  retirement or other  reduction in his  availability to P.C. does not
adversely  affect INMD revenues under the Management  Agreement,  but that there
are no assurances of such a transition's  success.  Jacobson may request INMD to
waive or reduce his repayment obligation by submitting a written transition plan
to INMD for its  consideration.  Jacobson shall submit such a transition plan as
soon as possible if he plans to reduce his availability to P.C., but in no event
less than six months  before the reduction in his  availability.  It is expected
that such a plan shall be modified as the result of discussions  among Jacobson,
P.C., and INMD,  that INMD's  acceptance of the plan shall be in accordance with
the Management  Agreement,  and that its agreement to waive or reduce Jacobson's
repayment  obligation  shall  be  mostly,  if not  wholly,  contingent  upon the
economic results of the  implementation of the plan and shall be secured by sums
owed Jacobson by P.C. and P.C.'s shareholders.  Approval of the request shall be
discretionary for INMD, but shall not be unreasonably withheld.

                  c.  Jacobson  may  assign  all or a  portion  of  his  payment
obligations  under this Section to a new or an existing  shareholder of P.C. who
has executed the agreements  with P.C. and INMD  contemplated by this Agreement,
subject to INMD's written  consent,  which shall not be  unreasonably  withheld.
Such  assignment  shall be reflected in the  Personal  Responsibility  Agreement
signed by the new shareholder of P.C. and in an amendment to this Agreement.

         4. P.C.'s Compliance with the Management Agreement.  Jacobson agrees to
exert his best  efforts to cause P.C. to fulfill each of its  obligations  under
the Management Agreement.

         5. Stock Purchase Agreement and Shareholders Employment Agreement.

                  a. P.C.  agrees to exert its best  efforts to: (I) comply with
the terms of the Stock Purchase Agreement and Shareholders  Employment Agreement
which,  if P.C.  does not  comply,  would  excuse  Jacobson  or any of the other
Physicians or other  physician  employees or shareholders of P.C. from complying
with his covenant not to compete with P.C., his  assignment of all  Professional
Revenues to P.C.  and other terms  confirming  that  physician's  commitment  to
practicing  medicine  solely through P.C. for a period of not less than five (5)
years and thereafter not to terminate his employment  without cause on less than
180 days written notice (the  "Exclusive  Practice  Covenants") and (ii) enforce
with  respect  to each of the  Physicians  and  other  physician  employees  and
shareholders  of P.C. the Exclusive  Practice  Covenants and Jacobson  agrees to
exert his best  efforts to cause P.C. to comply with each of the  aforementioned
obligations.

                  b. P.C. and Jacobson  further agree that INMD is a third party
beneficiary of the Exclusive Practice Covenants with respect to Jacobson and the
other Physicians and that the Exclusive Practice Covenants,  in the form that is
then most recently  approved by INMD, are hereby  incorporated in this Agreement
by reference and may be enforced by INMD as well as by P.C. P.C. and Jacobson

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further agree that the Exclusive  Practice  Covenants and any other terms of the
Stock  Purchase  Agreement  and  Shareholders  Employment  Agreement  may not be
amended or modified in a way which may  adversely  affect the interests of INMD,
including without limitations its rights under the Management Agreement, without
thirty (30) days prior written  notice to INMD and the written  consent of INMD,
which consent shall not be unreasonably withheld.

         6. Scope of Covenant Not to Compete.  Jacobson and P.C.  agree that the
scope and term of Jacobson's  covenant not to compete,  insofar as it is for the
benefit of INMD, shall be as follows:

                  a.   The   term  of  the   covenant   not  to   compete   (the
Non-Competition Period") shall be not less than the greater of five (5) years of
employment of Jacobson by P.C. or three (3) years after the  termination  of the
Shareholders  Employment Agreement,  whichever is greater, but in no event shall
extend beyond the first ten (10) years of  employment of Jacobson by P.C.,  that
employment  being deemed to have begun,  for purposes of this Agreement,  on the
initial effective date of this Agreement.

                  b. The  geographic  scope of the  covenant not to compete (the
"Service  Area") is twenty-five  (25) miles from any offices  maintained by P.C.
for the rendition of professional  or other medical  services to patients during
the last year of Jacobson's  employment by P.C. or  replacements of said offices
(the  "Current  Medical  Offices")  or offices  which it planned to establish or
acquire  during that year and in fact did  establish or acquire  within one year
after the termination of Jacobson's  employment (a "Planned Medical Office"). An
office  shall be  deemed  to have been a  Planned  Medical  Office  if P.C.  had
substantial  plans to open such  office in that city or area prior to such date,
which plans were  discussed at meetings of the Board of Directors or  committees
of P.C. which were attended by Jacobson or minutes of which, whether in draft or
approved  form,  were  provided to  Jacobson,  whether or not P.C.  entered into
leases,  ordered  equipment,   or  secured  regulatory  approval  prior  to  the
termination date.

                  c. During the Non-Competition  Period, Jacobson agrees that he
shall not advertize or market  Infertility  Services,  engage in the practice of
medicine,  or directly or indirectly,  own, operate, be employed by, be an agent
of, act as a consultant for. allow his name to be used by, or have a proprietary
interest in, any Medical  Practice which is  competitive  with P.C., or would be
competitive with P.C. if P.C. continued to operate, including but not limited to
a Medical  Practice  which owns,  operates,  contracts  with or manages  Medical
Offices within  twenty-five  (25) miles of a Current  Medical Office or Proposed
Medical Office of P.C..

                  d. For purposes of this  Section,  the  following  definitions
shall apply:

                           (1) The term  "Medical  Practice"  shall  include any
         form of  organization  in  which  Infertility  Services,  gynecological
         services,  or other medical diagnostic,  care or treatment services are
         provided to patients  of the Medical  Practice or of other  physicians,
         including but not limited to a sole proprietorship,  a partnership,  an
         association, a professional corporation,  a business corporation,  or a
         limited  liability  partnership  or  corporation,   a  laboratory,   an
         outpatient  clinic, a practice  management  company or medical services
         organization  (or  MSO).  However,  ownership  of  less  than 1% of the
         outstanding  securities of any class of a medical management or managed
         care  organization  traded on a  national  securities  exchange  or the
         NASDAQ National Market System will not be deemed to be engaging, solely
         by reason thereof, in the same business.


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                           (2) The term "Medical  Office"  includes any location
         at  which  the  professional  or  technical  component  of  Infertility
         Services are provided and any other location  which a Medical  Practice
         maintains for patient visits.

                  e. Separability. If the final judgment of a court of competent
jurisdiction  declares  that any term or provision of this Section is invalid or
unenforceable,  each Party  agrees that the court  making the  determination  of
invalidity or unenforceability will have the power to reduce the scope, duration
or area of the term or provision,  to delete  specific  words or phrases,  or to
replace any invalid or unenforceable  term or provision with a provision that is
valid and  enforceable and that comes closest to expressing the intention of the
invalid  or  unenforceable  term  or  provision,  and  this  Agreement  will  be
enforceable  as so  modified  after  the  expiration  of time  within  which the
judgment may be appealed.

                  f.  Clarification of Scope of Non-Competition  Covenant.  This
Agreement is not intended to prohibit the personal  performance  of medical care
by  Physician  on behalf of P.C.,  provided  those  services are for patients of
P.C.,  nor  prohibit  Physician  from  fulfilling  his contract  with P.C.,  nor
prohibit the  Physician  from  holding any position on the medical  staff of any
acute care hospital or the teaching staff of any university.

                  g. Acknowledgments.  P.C., INMD and Jacobson each acknowledges
that:  (I) the terms set forth in this Section are necessary for the  reasonable
and proper  protection  of the  interests of P.C. and INMD;  (ii) each and every
covenant and  restriction is reasonable  with respect to such matter,  length of
time  and  geographical  area;  (iii)  this  Agreement,   and  this  Section  in
particular,  shall be enforceable notwithstanding any dispute as to the sums and
timing of payments to Jacobson or other  disputes  under this  Agreement  or the
Stock Purchase Agreement or the Shareholders Employment Agreement;  and (iv) the
P.C.  and INMD have been  induced to enter into this  Agreement  and their other
respective  agreements  with  Jacobson,  in part, due to the  representation  by
Jacobson  that he will  abide  by and be bound by the  aforesaid  covenants  and
restraints.

         7. Commitment to Pay Management Fees.  Jacobson has agreed in the Stock
Purchase Agreement and Shareholder Employment Agreement not to compete with P.C.
during  the term of his  employment  by P.C.  and for at least  three  (3) years
thereafter,  and recognizes  that in the event that he should compete with P.C.,
INMD would suffer damages in addition to the loss of Jacobson's unique services.
Jacobson  therefore agrees that during the term of his  Shareholders  Employment
Agreement with P.C., and during the Non-Competition Period thereafter,  he shall
be obligated, with respect to each month in which he renders services which earn
Physician  and  other  Professional  Revenues,  as  defined  in  the  Management
Agreement, that are not assigned to and collected by P.C., or offers services or
assists other persons in offering services in the Service Area which are similar
to any of those  offered by P.C.  or planned to be offered by P.C.  while he was
still a director, officer or shareholder of P.C. or active in providing services
on behalf of P.C., he shall owe INMD management fees equal to one-twelfth of:

                  a.  One-third  of the  Cost  of  Services  as  defined  in the
Management  Agreement,  which are incurred in the twelve  months  preceding  the
first  month  in which  INMD,  in the  reasonable  exercise  of its  discretion,
concludes  that  Jacobson  was  engaging  in  such  competitive  acts  so  as to
materially adversely affect P.C.'s operations (the "Pre-Competition Period").


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                  b.  One-third  of the Base  Management  Fee which INMD  earned
during the Pre- Competition Period.

                  c.  One-third  of any  other  fees  earned  by INMD  under the
Management Agreement during the Pre-Competition Period.

                  d. One-third of any advances or other payments owed by P.C. to
INMD at the end of the Pre-Competition Period.

These  fees  shall  be  payable  notwithstanding  the  dissolution,  insolvency,
receivership  or  bankruptcy  of P.C.  and any breach of P.C.'s  contracts  with
Jacobson occasioned by such dissolution, insolvency, receivership or bankruptcy.

         8.  New  Shareholders.   P.C.  and  Jacobson  shall  require  each  new
Shareholder  of P.C. to enter into an agreement with INMD on  substantially  the
same terms as this Agreement.  Any reallocation of responsibility  for repayment
under  Section  1 of this  Agreement  and the  parallel  provision  in the Asset
Purchase  Agreement  shall  be set  forth  in  the  new  shareholder's  Personal
Responsibility Agreement and in an amendment to this Agreement.

         9.  Force  Majeure.  No party  shall be liable  to the other  party for
failure to perform any of the  services  required  under this  Agreement  in the
event of a strike, lockout, calamity, act of God, unavailability of supplies, or
other  event over which  such  party has no  control,  for so long as such event
continues and for a reasonable period of time thereafter,  and in no event shall
such party be liable for  consequential,  indirect,  incidental  or like damages
caused thereby.

         10.  Equitable   Relief.   Without  limiting  other  possible  remedies
available to a  non-breaching  party for the breach of the  covenants  contained
herein, injunctive or other equitable relief shall be available to enforce those
covenants,  such relief to be without the  necessity  of posting  bond,  cash or
otherwise.  If any restriction  contained in said covenants is held by any court
to be unenforceable or unreasonable,  a lesser  restriction shall be enforced in
its place and remaining  restrictions therein shall be enforced independently of
each other.

         11.  Confidential  Information.  Jacobson  acknowledges  and  agrees to
maintain  the  confidentiality  of INMD and  P.C.  Confidential  Information  as
defined in the Management Agreement and in any agreements he may have with P.C.,
and that any  notice  to INMD  that  documents  or  other  information,  however
maintained, is Confidential  Information,  shall be deemed, for purposes of this
Agreement, to be notice to him that it is Confidential Information.

         12. Prior  Agreements;  Amendments.  This Agreement,  together with the
Management Agreement and the other agreements referenced herein,  supersedes all
prior agreements and understandings between the parties as to the subject matter
covered hereunder,  and this Agreement may not be amended,  altered,  changed or
terminated orally. No amendment,  alteration,  change or attempted waiver of any
of the  provisions  hereof shall be binding  without the written  consent of the
parties, and such amendment,  alteration, change, termination or waiver shall in
no way affect the other terms and  conditions  of this  Agreement,  which in all
other respects shall remain in full force.


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         13.  Assignment;  Binding  Effect.  This  Agreement  and the rights and
obligations  hereunder may not be assigned  without the prior written consent of
the parties, and any attempted assignment without such consent shall be void and
of no force and  effect,  except  that INMD may  assign  this  Agreement  to any
subsidiary or affiliate of INMD without the consent of Jacobson.  The provisions
of this  Agreement  shall be binding  upon and shall inure to the benefit of the
parties'  respective  heirs,  legal  representatives,  successors  and permitted
assigns.

         14. Waiver of Breach. The failure to insist upon strict compliance with
any of the terms, covenants or conditions herein shall not be deemed a waiver of
such terms,  covenants or conditions,  nor shall any waiver or relinquishment of
any right at any one or more times be deemed a waiver or  relinquishment of such
right at any other time or times.

         15. Governing Law. This Agreement shall be governed by and construed in
accordance  with  the laws of the  State of  California  to the  fullest  extent
permitted by law,  without  regard to the  application of conflict of law rules.
Any and all claims,  disputes,  or  controversies  arising under,  out of, or in
connection  with this  Agreement or any breach  thereof,  shall be determined by
binding  arbitration  in the State of  California,  County  of  Contra  Costa or
Alameda  (hereinafter  "Arbitration").  The party  seeking  determination  shall
subject any such dispute,  claim or controversy to either (I)  JAMS/Endispute or
(ii)  the  American  Arbitration  Association,   and  the  rules  of  commercial
arbitration of the selected  entity shall govern,  except with regard to actions
for injunctive  relief.  The Arbitration shall be conducted and decided by three
(3) arbitrators, unless the parties mutually agree in writing at the time of the
Arbitration, to fewer arbitrators. In reaching a decision, the arbitrators shall
have no authority to change or modify any provision of this Agreement, including
without limitation,  any liquidated damages provision. Each party shall bear its
own  expenses  and  one-half  the  expenses  and costs of the  arbitrators.  Any
application  to compel  Arbitration,  confirm  or vacate  an  arbitral  award or
otherwise  enforce this  paragraph  shall be brought either in the Courts of the
State of  California  or the  United  States  District  Court  for the  Northern
District of  California,  to whose  jurisdiction  for such  purposes the parties
hereby irrevocably consent and submit.

         16. Separability.  If any portion of the provisions hereof shall to any
extent be invalid or  unenforceable,  the  remainder of this  Agreement,  or the
application of such portion or provisions in  circumstances  other than those in
which it is held invalid or unenforceable,  shall not be affected  thereby,  and
each portion or provision of this  Agreement  shall be valid and enforced to the
fullest  extent  permitted by law, but only to the extent the same  continues to
reflect  fairly the intent and  understanding  of the parties  expressed by this
Agreement taken as a whole.

         17. Headings; Capitalized Terms. Section and paragraph headings are not
part of this  Agreement  and are  included  solely for  convenience  and are not
intended to be full or accurate  descriptions of the contents thereof.  The term
"Infertility  Services" and any other  capitalized  term which is not defined in
this  Agreement  shall  have  the  same  definition  it has  in  the  Management
Agreement.

         18. Notices.  Any notice  hereunder shall have been deemed to have been
given only if in writing and either  delivered in hand or sent by  registered or
certified mail, return receipt requested,  postage prepaid,  or by United States
Express Mail or other commercial  expedited  delivery service,  with all postage
and delivery charges prepaid, to the addresses set forth below:


                                        7





          If for INMD at:

          IntegraMed America, Inc.
          One Manhattanville Road
          Purchase, NY 10577-2100
          Attention: Judith Connell, Vice President

          With a copy to:

          IntegraMed America, Inc.
          One Manhattanville Road
          Purchase, NY 105277-2100
          Attention:  Claude White, General Counsel

          If for Jacobson at:

          Arnold Jacobson, M.D.
          2476 Alamo Glen Drive
          Danville, California 94526.

          If for P.C. at:

          Bay Area Fertility And Gynecology Medical Group
          5601 Norris Canyon Road, Suite 300
          San Ramon, California 94583
          Attention:  President

          With a copy to:

          Frank Gamma, Esq.
          Charles Bond & Associates
          821 Bancroft Way
          Berkeley, California 94710-0226

         Any party hereto, by like notice to the other party, may designate such
other address or addresses to which notice must be sent.


         IN WITNESS  WHEREOF,  this  Agreement  has been executed by the parties
hereto as of the day and year first above written.


INTEGRAMED AMERICA, INC.,
A DELAWARE CORPORATION

                                       

BY: /s/ Dwight Ryan
    --------------------------
    DWIGHT P. RYAN

ITS Vice President and CFO



ARNOLD JACOBSON, M.D.

    /s/ Arnold Jacobson
    --------------------------
    ARNOLD JACOBSON, M.D.


BAY AREA FERTILITY AND GYNECOLOGY MEDICAL GROUP,  INC.,
A CALIFORNIA PROFESSIONAL CORPORATION



BY:  /s/ Arnold Jacobson
     -------------------------
     ARNOLD JACOBSON
ITS: President


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