NM_023067.4:c.297_311del (p.Gln99_Arg103del) is an in-frame deletion of 15 nucleotides in exon 1 of FOXL2, removing five amino acids (Q99-R103) in a non-repeat region of the gene. Under generic ACMG/AMP 2015, this qualifies for PM4 at moderate strength. The variant is absent from gnomAD v2.1, v4.1, and gnomAD-Canada v1.0, meeting the <0.1% allele frequency threshold for PM2 at supporting level.¹ PVS1 is not met: the variant is an in-frame deletion that does not fall into the default null-variant buckets under PMC6185798 (nonsense, frameshift, or canonical splice). The pvs1_variant_assessment confirms generic PVS1 is not applicable.² No functional studies, de novo data, cosegregation data, case-control data, computational evidence of deleteriousness, or ClinVar classification are available for this variant. Total evidence: 1 moderate (PM4) + 1 supporting (PM2). Under ACMG/AMP 2015 combination rules (PMID:25741868), this is insufficient for likely pathogenic (which requires ≥2 moderate or ≥1 moderate + ≥2 supporting). The variant is classified as a Variant of Uncertain Significance (VUS).³