AMENDMENT NO. 1 TO MANAGEMENT AGREEMENT

                                     BETWEEN

                            INTEGRAMED AMERICA, INC.

                                       AND

              BAY AREA FERTILITY AND GYNECOLOGY MEDICAL GROUP, INC.


         THIS  AMENDMENT NO. 1 TO MANAGEMENT  AGREEMENT ( "Amendment  No. 1") is
dated  April 5, 1998 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 ("Bay Area Fertility").

                                    RECITALS:

         WHEREAS,  INMD  and  Bay  Area  Fertility  entered  into  a  Management
Agreement  dated  January  7,  1997  (the  "Management  Agreement")which  became
effective as of January 8, 1997 ("Effective Date"); and

         WHEREAS,  INMD is willing to grant to each of Donald Galen,  MD, Arnold
Jacobson,  MD and Louis  Weckstein,  MD, the  stockholders of Bay Area Fertility
("Stockholders"),  warrants  to acquire  15,000  shares,  respectively,  of INMD
Common  Stock (the  "Warrants")  at a price equal to the  closing  price of INMD
Common Stock on the date of this  Agreement,  and with an expiration date of the
Warrants that is five (5) years from issuance.; provided, the Stockholders cause
Bay Area  Fertility to amend the  Management  Agreement so as to extend the term
from 20 years to 25 years; and

         WHEREAS,  Bay Area  Fertility,  based on approval of  Stockholders,  is
willing to extend the  Management  Agreement  for five (5) years so as to expire
twenty-five (25) years from the Effective Date.

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

         1. The first  sentence of Section 7.2 of The  Management  Agreement  is
hereby deleted and the following sentence is hereby substituted therefor:

                  "The term of this  Agreement  shall begin on the Closing  date
                  and shall expire twenty-five (25) years after such date unless
                  earlier terminated pursuant to Article 8, below."






         2. All other  provisions of the Management  Agreement,  not in conflict
with this Amendment No. 1 remain in full force and effect.

         3. This  Amendment  No. 1 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.

         4. Upon  execution of this Amendment by Bay Area  Fertility,  INMD will
issue the Warrants to the Stockholders.

         IN WITNESS  WHEREOF,  the parties have signed this  Amendment No. 1 the
date first above written.


INTEGRAMED AMERICA, INC.



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



BAY AREA FERTILITY AND GYNECOLOGY MEDICAL GROUP, INC.



By:/s/Arnold Jacobson
   --------------------------
   Arnold Jacobson, President