Irving Stein

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Biography

• Born September 19, 1887 in Chicago, Illinois
• 1910– graduated BS, University of Michigan
• 1912 – MD, Rush Medical College, Chicago
• 1914 – assistant in surgery at Michael Reese Hospital’s Department of Obstetrics and Gynecology
• 1926 – joined by Michael Leventhal (1901-1971) at Michael Reese Hospital began to conduct research together on causes of sterility in women
• Died October 11, 1976 in Glencoe, Illinois

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Medical Eponyms

Stein–Leventhal Syndrome (1934) [polycystic ovarian syndrome (PCOS)]

Complex endocrine and metabolic disorder characterised by anovulation, amenorrhoea / oligomenorrhoea, infertility, obesity, hirsutism, insulin resistance, and polycystic ovaries.

1930s – Stein and Leventhal established that women showing symptoms of infertility, excess body hair, and irregular menstruation also had irregular ovaries.

1934 – Stein and Leventhal presented their experience with seven patients amenorrhea, hirsutism, obesity, and enlarged polycystic ovaries investigated by ovarian wedge resection, to a meeting of the Central Association of Obstetrics and Gynecologists in New Orleans [Published 1935]

1. A series of seven cases is herewith reported in which amenorrhea was associated with the presence of bilateral polycystic ovaries.
2. Bilateral polycystic ovaries are most likely the result of hormonal influences and not the result of inflammatory change.
3. The diagnosis of ovarian pathology is greatly facilitated by the use of pneumoroentgenography.
4. The treatment of the amenorrhea with estrogenic hormone in the patients referred to proved unsatisfactory.
5. Surgical treatment, consisting of wedge-resection of the cystic cortex of the ovaries, was successful in completely restoring physiologic function. Menstruation in every instance became normal and remained so during the period of observation. Pregnancy followed in two patients.

Stein, Leventhal 1935

1950s – Stein continued to follow up his patients. Researchers began using the term Stein-Leventhal syndrome to define the range of the symptoms described. They broadened the syndrome of persistent
anovulation to include clinical manifestations including insulin resistance and hyperinsulinemia, and hyperandrogenism.

…While bilaterally enlarged ovaries associated with menometrorrhagia had been described, such a finding in relation to amenorrhea was unusual enough to warrant biopsy of the ovaries for etiologic purposes. To obtain sufficient material, the biopsy was done by excising a wedge-shaped portion of each ovary. Following the wedge resection, the women menstruated regularly and some of them readily conceived. Hence it became evident that ovulatory cycles ensued after this simple surgical procedure.

Within the next decade, a history of secondary amenorrhea and/or sterility, and the findings of uterine hypoplasia, breast hypoplasia, and hirsutism became associated with bilaterally and symmetrically enlarged ovaries and was recognized in the medical literature as the Stein-Leventhal syndrome.

The surgery originally intended for biopsy alone yielded no specific data concerning etiology; instead, it eventuated in the identification of a syndrome and, at the same time, became a successful method of treatment.

Stein, 1959

1965 – After 30 years of follow up, Stein concluded that the return of fertility was permanent in women with Stein-Leventhal syndrome who received a wedge resection.

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Major Publications

• Stein IF Sr, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. American Journal of Obstetrics and Gynecology 1935; 29: 181-191. [Stein–Leventhal Syndrome]
• Stein IF Sr, Cope EJ. Trichomonas Vaginalis (Donné), a Preliminary Study. American Journal of Obstetrics and Gynecology 1931; 22: 368–76.
• Stein IF Sr. Gynecographic Aid in the Diagnosis of Ectopic Pregnancy. American Journal of Obstetrics and Gynecology 1942; 43: 400–9.
• Stein IF Sr. Bilateral Polycystic Ovaries. American Journal of Obstetrics and Gynecology 1945; 50: 385–98.
• Stein IF. The management of bilateral polycystic ovaries. Fertil Steril. 1955;6:189 –205.
• Stein IF Sr. The Stein-Leventhal syndrome; a curable form of sterility. N Engl J Med. 1958 Aug 28;259(9):420-3.
• Stein IF Sr. The Stein-Leventhal Syndrome. Clinical Obstetrics and Gynecology 1959; 2: 207–17.
• Stein IF Sr. Controversial aspects of the Stein-Leventhal syndrome. Int J Fertil. 1962 Apr-Jun;7:123-30.
• Stein IF. Multiple pregnancy following wedge resection in The Stein-Leventhal syndrome. Int J
• Fertil. 1964; 17: 343–350
• Stein IF Sr. Duration of Fertility Following Ovarian Wedge Resection. Stein-Leventhal Syndrome. West J Surg Obstet Gynecol. 1964 Jul-Aug;72:237-42
• Stein IF. La durée de la fertilité après résection cunéiforme de l’ovaire au cours du syndrome de Stein-Leventhal [Duration of fertility after wedge resection of the ovary in Stein-Leventhal syndrome]. Gynecol Prat. 1967;18(1):9-19.

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References

Biography

• Powell JL. Powellʼs Pearls: Irving Freiler Stein, MD (1887–1976) and Michael Leo Leventhal, MD (1901–1971). Journal of Pelvic Medicine and Surgery, 2008; 14(5): 413–414.
• Azziz R, Adashi EY. Stein and Leventhal: 80 years on. Am J Obstet Gynecol. 2016 Feb;214(2):247.e1-247.e11.
• Darby A. Irving Freiler Stein Sr. (1887–1976). Embryo Project Encyclopedia

Eponymous terms

• Dastur Adi E, Tank PD. Irving Stein, Michael Leventhal and a slice of endocrine history. J Obstet Gynaecol India. 2010 Apr;60(2):121–2.

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