• Guo-Sheng Deng, Yu-Qing Lai, Bo-Wen Luo, Yu-Di Luo, Ling-Ling Zhu, Zeng-Yu Yang, Keng Feng, De-Rong Li, and Xiang Li.
• Clinical Laboratory, Yulin Maternal and Child Health Care Hospital, Yulin, Guangxi, China.
• Medicine (Baltimore). 2025 Jan 10; 104 (2): e41255e41255.

RationaleThis study investigates the genetic cause of primary infertility and short stature in a woman, focusing on maternal X chromosome pericentric inversion and its impact on offspring genetic outcomes, including deletions at Xp22.33 and Xp22.33p11.3, and duplications spanning Xq27.3 to the distal end of the X chromosome's long arm.Patient ConcernsThe proband presented with primary infertility, menstrual irregularities, and ultrasound findings indicating a small uterus.DiagnosesPeripheral blood G-banded karyotype analysis and single nucleotide polymorphism array analysis revealed a 46,X,rec(X)dup(Xq)inv(X)(p11.3q27)dmat karyotype in the proband, inherited from her mother. Genetic testing identified pathogenic deletions at Xp22.33 and Xp22.33p11.3, and a pathogenic duplication at Xq27.3q28.InterventionsGenetic counseling and pedigree analysis were conducted to trace the maternal origin of the pericentric inversion and assess recurrence risks.OutcomesThe study confirmed the maternal X chromosome pericentric inversion caused the observed genetic abnormalities, with a 50% recurrence risk for X-linked inheritance.LessonsMaternal X chromosome pericentric inversion significantly affects offspring genetic outcomes. Assisted reproductive technologies, including in vitro fertilization with preimplantation genetic testing, are recommended to reduce recurrence risks in future pregnancies. Prenatal genetic testing is advised for natural conception to ensure fetal genetic health.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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