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Psychiatry 7 , e1137 (2017) PubMed

These can include not having vaginal intercourse before or during ovulation, using the pull-out method (withdrawal), using vaginal gels or a barrier method like using condoms or internal condoms

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Your doctor also will review your medical history for medical illnesses (diabetes, immune disorders) or surgeries, such as stomach removal, that can lead to B 12 deficiency