A CCNA1 Missense Variant Associated With Chromatid Non‐Disjunction in Abnormal‐Headed Sperm and Male Infertility

ABSTRACT Background Macrozoospermia is a rare form of teratozoospermia characterized by tetraploids, large‐headed spermatozoa with multiple flagella, usually caused by bi‐allelic AURKC mutations. The etiology of atypical phenotypes with a lower proportion of large headed spermatozoa and single flagella however often remains unresolved. Objective To investigate the genetic cause of severe sperm‐head abnormalities with moderate macrozoospermia without multiflagellated spermatozoa in a patient with repeated ICSI failure. An infertile male with three failed ICSI attempts underwent semen analysis, revealing complete teratozoospermia, including 25% macrocephalic spermatozoa. Methods Multi‐probe FISH targeting chromosomes 13, 18, 21, X, Y assessed chromosomal segregation. Whole‐exome sequencing (WES) was performed to identify a candidate variant associated with meiotic abnormalities. Results FISH analysis revealed a high proportion of spermatozoa with n (23) chromosomes and 2c DNA content, consistent with sister chromatid non‐disjunction during meiosis II. WES identified a homozygous missense variation in CCNA1 , coding for a protein described to be essential for meiotic progression and chromatin remodeling in male germ cells. Discussion The variant affects a highly conserved residue within a functional domain and is predicted to be deleterious. This study establishes the first clinical association between CCNA1 mutations and chromatid non‐disjunction in human spermatogenesis. It highlights the limitations of current morphology‐based diagnostic thresholds and supports cytogenetic and genomic assessment for severe teratozoospermia (especially head abnormalities) and ART failure. Conclusion Expanding genetic screening panels to include CCNA1 may improve diagnostic precision and clinical management in atypical macrozoospermia cases.