King Tut had a "juvenile aseptic bone necrosis" which made it hard for him to walk.
Stillbirth was a common consequence of royal inbreeding.
Despite 300 years of inbreeding, the Ptolemys didn't really have any major genetic issues.
Elissa of Tyre (aka Dido) was married to her uncle.
Incan princes often married their sisters.
Genetics is Probabilistic
Incestuous dynasties were were common in ancient Egypt, Hawaii, the Inca kingdoms, pre-industrial Thailand, Phoenicia and several African realms. [Source]
Siblings or Cousins?
Incestuous European dynasties like the Hapsburgs tended to marry their cousins, whereas more ancient marriages tended to be between siblings. [Source]
Who Rules Next?
While yes, varieties of sibling marriage were common in Egypt, so was polygamy and the products of incestuous marriages were not typically the heir. [Source]
Meeting Times
Marriages between individuals who grew up together young age are typically sexless due to something a type of sibling avoidance called the Westermarck effect. [Read More!]