Supplementary material J Med Genet Supplementary Table 1: Number of variants in the exome sequence of patient IV-3 with allele frequency of less than 1% in the public databases: 1000 Genomes, gnomAD and ExAC Browsers and the reason for their negation as the causative mutation. The cause of negation of variants identified by WES Number of variants that were negated Common variants according to our internal laboratory Exome database of 5 the Bedouin population Common variants according to a database of healthy Saudi individuals with 4 LOF in varies genes (Alsalem et al. 2013) Supportive information for negation by low prediction for damage (Omicia score) 8 ( SIFT, PolyPhen, phyloP – Vertebrate, splice prediction) Segregation (the patient IV-9 not presenting variation in homozygosity) 9 Mouse model normal for male fertility ( MGI- Mouse Genome 3 Informatics) Low expression in testis 2 Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825 Supplementary material J Med Genet Supplementary Table 2: List of variants that were negated by not segregating as expected for a causative mutation in patient IV-9. Positions are according to GRCh37/hg19. Variants identified by WES negated by not segregating as Zygosity in Patient expected for a causative mutation IV-9 1 Chromosome 1:150444609 , c. 3185G>A p. Arg1062His Normal homozygote Regulation Of Nuclear Pre-MRNA Domain Containing 2 (ref allele) (RPRD2) gene. 2 Chromosome 1:156212617, c.168G>A, p. Trp56*, Bone Gamma- Normal homozygote Carboxyglutamate Protein (BGLAP) gene. (ref allele) 3 Chromosome 2:190593090, c. 2975G>A, p. Gly992Glu, Ankyrin Heterozygote And Armadillo Repeat Containing (ANKAR) gene. 4 Chromosome 2:196822038, c. 3025C>T, p. Arg1009*, Dynein Heterozygote Axonemal Heavy Chain 7 (DNAH7) gene. 5 Chromosome2:197559839, c. 1579A>C, p. Met527Leu, Coiled- Heterozygote Coil Domain Containing 150 (CCDC150) gene. 6 Chromosome 2:203948150, c. 893A>G , p. Tyr298Cys, Heterozygote Neurobeachin Like 1 (NBEAL1) gene. 7 Chromosome 2:204161591, c. 1349C>T , p. Ser450Leu, Cytochrome P450 Family 20 Subfamily A Member 1 (CYP20A1) Heterozygote gene. 8 Chromosome 3:73434914, c. 1541A>G , p. Asp514Gly, PDZ Heterozygote Domain Containing Ring Finger 3 (PDZRN3) gene. 9 Chromosome 15:75651960, c. 1948+1G>A, splice donor, Normal homozygote Mannosidase Alpha Class 2C Member 1 (MAN2C1) gene. (ref allele) Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825 Supplementary material J Med Genet Supplementary Table 3: Full list of the 31 homozygous variants that were negated and the cause of negation. Scores used to compute the omicia score: MutationTaster, Polyphen-2, SIFT, phyloP – Vertebrate, phyloP – Placental and phyloP – Primate. Variants identified by WES negated by presenting with a frequency of more than 3% in the internal laboratory Exome database of the Bedouin population Frequency in Position internal Bedouin oN Gene Change Effect database (72 dbSNP individuals) missense c. 5050C>G chr1:152189055 100% heterozygotes 1 1 HRNR splice site impact rs4845749 p. Arg1684Gly c. 22.2.% chr1:175129924 in-frame deletion 2 2 KIAA0040 217_225delAAGAAGAAG heterozygotes rs150137790 p. Lys73_Lys75del 45.8% c. 195C>A chr1:175129955 heterozygotes 3 3 KIAA0040 missense rs3208835 8.33% homozygotes p. Asn65Lys ZNF717 chr3:75788152 c. 622A>G missense 36.1% rs76179262 heterozygotes 4 p. Thr208Ala 6.94% chr14:106091355 c. 539A>T heterozygotes 5 IGHG4 missense rs376761875 p. Tyr180Phe 1.38% homozygotes Variants identified by WES negated by presenting with a frequency of more than 2% in the database of healthy Saudi individuals with LOF in the listed genes (Alsalem et al. 2013) Position No Gene Change Effect dbSNP c. 2003C>T chr1:110884030 1 1 RBM15 missense 2.6% heterozygotes rs150900331 p. Ala668Val c. 1703G>C chr1:158639328 2 SPTA1 missense 2.6% heterozygotes rs200829664 p. Arg568Pro Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825 Supplementary material J Med Genet c. 167A>C chr15:76254253 3 3 NRG4 missense 3.9% heterozygotes rs768230628 p. Gln56Pro c. 2408A>T chr2:167289012 4 SCN7A missense 6.5% heterozygotes rs148715564 p. Asp803Val Supportive information for negating variants identified by WES by low prediction for damage (Omicia score) Omicia Score Position No Gene Change Effect Polyphen SIFT dbSNP 2 2 c. 466C>T 0.472 chr1:117663358 1 1 TRIM45 missense rs139632476 p. His156Tyr 0.5 0.054 c. 1550C>T 0.166 2 TCHHL1* chr1:152058608 missense p. Thr517Ile 0.649 0.271 c. 1103C>T 0.223 chr1:155002634 3 3 DCST2 missense rs138589439 p. Ala368Val 0.288 0.349 c. 4068T>A 0.095 4 4 IQGAP3 chr1:156502807 missense p. Asp1356Glu 0.332 1 c. 380G>A 0.561 chr1:184041317 5 TSEN15 missense rs184488794 p. Arg127Gln 0.011 0.435 c. 3040G>A 0.144 chr2:219508199 6 ZNF142 missense rs201639604 p. Glu1014Lys 0 0.64 c. 979G>T 0.052 7 STOML1 chr15:74277024 missense p. Ala327Ser 0 0.83 c. 438G>C 0.636 chr16:77465249 8 ADAMTS18* missense rs151326659 p. Gln146His 0.197 0.174 c. 252A>T missense 0.056 9 CRYGC chr2:208994165 p. Gln84His splice site impact 0 1 c. 230T>C 0.243 chr14:106552409 10 IGHV3-9 missense rs140101036 p. Ile77Thr - - Variants identified by WES Negated by not being homozygous in patient IV-9 Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825 Supplementary material J Med Genet Omicia Score Position No Gene Change Effect Polyphen SIFT dbSNP 2 2 c. 3185G>A 0.914 chr1:150444609 1 1 RPRD2 missense rs201638526 p. Arg1062His 0.999 0 c. 168G>A 0.623 chr1:156212617 2 2 BGLAP stop gained rs768282982 p. Trp56* - - c. 2975G>A 0.884 chr2:190593090 3 3 ANKAR missense rs139078107 p. Gly992Glu - 0 c. 3025C>T 0.475 chr2:196822038 4 4 DNAH7 stop gained rs371925699 p. Arg1009* - - c. 1579A>C missense 0.188 chr2:197559839 5 5 CCDC150 rs199761560 p. Met527Leu splice site impact 0.001 0.775 c. 893A>G 0.708 6 NBEAL1 chr2:203948150 missense p. Tyr298Cys 0.911 0 c. 1349C>T 0.336 7 CYP20A1 chr2:204161591 missense p. Ser450Leu 0.229 0.008 c. 1541A>G 0.896 chr3:73434914 8 PDZRN3 missense rs763924260 p. Asp514Gly 0.973 0.003 splice donor 0.584 9 9 MAN2C1 chr15:75651960 c. 1948+1G>A splice site impact - - Variants identified by WES negated by the Mouse model presenting with normal male fertility ( MGI- Mouse Genome Informatics Omicia Score Position No Gene Change Effect Polyphen SIFT dbSNP 2 2 c. 188C>G 0.421 chr1:146057424 1 1 NBPF11 missense rs781994456 p. Ser63Cys - - 0.8 c. -478_- 2 2 FAM78B chr1:166136070 splice donor 472+17delGGGGC... - - Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825 Supplementary material J Med Genet PMS1 0.252 3 3 chr2:190670372 c. 316-6 C>A splice region - - *Low expression in testis Reference: Alsalem AB, Halees AS, Anazi S, Alshamekh S, Alkuraya FS. Autozygome sequencing expands the horizon of human knockout research and provides novel insights into human phenotypic variation. PLoS Genet 2013;9:e1004030. Arafat M, et al. J Med Genet 2020;0:1–10. doi: 10.1136/jmedgenet-2019-106825.