cryptic pregnancy causes

But the fact is, there's a small number of people who progress several months (or even all the way until labor begins) without ever realizing there's a baby on the waya phenomenon known as cryptic pregnancy or stealth pregnancy. However, the following factors may have a role: Lack of or misidentified pregnancy symptoms: As mentioned, women may mistake common pregnancy symptoms for something else. 3 Important Things to Know, Dysmorphia VS Dysphoria: Know the Basic Differences. They might not be aware that they are pregnant or be in denial about it. 1.1) Absence of Pregnant Symptoms: 1.2) Irregular Menstrual Cycle: 1.3) Intermittent Spotting: 1.4) Age and Fertility: 1.5) If you had been pregnant recently, the hormones may not have stabilized at their usual level within this time and need some time for the hormone levels to get back to their levels prior to pregnancy. Emotionally speaking, this can be an incredible shock, especially if the mother doesnt have a strong support system and the father of the baby isnt present in the picture, or the couple had no plans to become parents anytime soon. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. But it's easy to miss early signs of pregnancy if you arent looking for them. If you think you're pregnant and your urine is very diluted (appears clear like water), consider repeating the test again first thing in the morning when urine is more concentrated. Similarly, people who are breastfeeding or recently gave birth might dismiss pregnancy symptoms if they think ovulation hasn't returned yet. And while that may be true, it doesn't mean they can't get pregnant.. Cryptic pregnancy can be dangerous because it often means a lack of prenatal care and can lead to an unattended birth. But one thing is common to all these factors is the risk of hormonal imbalance. A couple who is wholly unprepared for parenthood might find themselves facing some very difficult decisions if they find themselves in this situation. Learn more about how cryptic pregnancies can happen, as well as the common causes of "I didn't know I was pregnant" situations. But some women don't have any pregnancy symptoms, or they have symptoms that are very mild. WebIn fact, the cause of cryptic pregnancy can generally be traced to hormonal imbalance generally caused due to the following reasons PCOS Cystic developments in the ovaries can cause hormonal imbalance, thus leading to stealth pregnancy. WebPolycystic ovary syndrome (PCOS), which causes irregular or elongated hormone cycles, can also cause a cryptic pregnancy. A secondary, less common cause of cryptic All rights reserved. Signs/Symptoms of a Cryptic Pregnancy & Bleeding/Continued Periods During a Cryptic Pregnancy, Ultrasounds, CT scans, MRIs & X-Rays During a Cryptic Pregnancy. What Do Braxton Hicks Contractions Feel Like? They might even have to deliver the baby alone and unaided if they dont make it to a hospital. Military Medicine 165(7): 566-8. https://pubmed.ncbi.nlm.nih.gov/10920660/ [Accessed February 2021], Orvos H et al. A slew of risk factors that may contribute to your chances of having a cryptic pregnancy. Abstract: https://www.karger.com/Article/Purchase/503151 [Accessed February 2021], Neifert, P. & Bourgeois, J. Usually, a missed period sets off alarms in a womans head, especially if she has regular menstrual cycles. However, continued use of birth For example, picking up rare genetic abnormalities during early ultrasounds and bloodwork can be missed, says Kirkham. Struggling with infertility can also lead to denial of pregnancy. Can you be pregnant and get a negative pregnancy test? What causes a cryptic pregnancy? Pregnancy hormone levels follow a predictable pattern and rise exponentially quite quickly," says Kirkham. Some of the most common symptoms include: It is quite disturbing that cryptic pregnancy is usually not confirmed via urine tests or blood tests. Cryptic pregnancy can be caused by several factors, some of which may be genetic. Though this sounds unlikely, it's not rare. What makes labour unique for a cryptic pregnancy is that you may not be anticipating it at all, which can cause intense psychological distress whilst giving birth. An error on the part of the ultrasound technician. Kirkham says that cryptic pregnancies are generally most common among people who dont get regular periods for any number of reasons. "Abnormal pregnancies like ectopic pregnancies rise slower, but they are still able to be confirmed by a blood testwhich is fortunate as they can be life-threatening. This category only includes cookies that ensures basic functionalities and security features of the website. Women in the reproductive age of their life should be careful and aware of their bodies and should know that she might have cryptic pregnancy. This could result in an unplanned gestation that goes unnoticed. Some women dont begin to show or gain weight until much later in gestation. Cryptic pregnancies are more common in women who: Have conditions that cause irregular or skipped periods, such as polycystic ovarian syndrome (PCOS) or Typically, a positive test result is nearly always accurate. Also, regular menstruation also lengthens the gestation period for quite some time. The gestation period of a cryptic pregnancy is way longer than that of a normal pregnancy because the fetus cannot develop properly due to the lack of hCG hormones and because they cannot be absorbed by the body. Plus, a lot of patients with PCOS are told that their fertility is decreased. Some birth control pills may release hormones that have the effect of suppressing the normal hormones in women and are high in progesterone. They can organise an ultrasound scan to check. Who is more likely to have a cryptic pregnancy? Also check the date on the package to make sure the pregnancy test isn't expired. According to medical professionals, potentially fatal complications might occur in up to 15% of births. These are. New moms are busy and don't expect their period to come back," says Kirkham. Pregnancy is usually obvious in expectant mothers. This could certainly cause someone to have a false sense of assurance that they aren't pregnant when, in fact, they actually are. Typically, cryptic pregnancies happen to people who have hormonal imbalances either due to natural causes, hormonal birth control, or approaching perimenopause. It's important to realize that it is possible to get pregnant during perimenopause, even if you have an irregular cycle. Your email address will not be published. Quitting drinking and smoking are at the top of the list, in addition to eating well and taking prenatal vitamins. Here, we've listed some factors that can make a cryptic pregnancy more likely to occur. What Happens to Your Body and Hormones After a Miscarriage, 8 Best Pregnancy Tests and How to Use Them. 2010. Estrogen has a strong bearing on the symptoms of pregnancy such as growth of breasts, morning sickness weight gain. However, women without a history of mental illness are likely to not realize they are pregnant due to physical rather than emotional reasons, and its important to make a distinction between the two. Its very possible to have a healthy baby even if youre not aware that youre pregnant until the later stages of the pregnancy. Although they are rare, stealth pregnancies are not unheard of either. Alternatively, other signs of pregnancy like foetal movement, minor weight gain, and fatigue could be dismissed as the result of dietary or lifestyle choices. If there are signs of menopause then it is very likely that pregnancy symptoms will not show up. They can also do an ultrasound to confirm whether or not youre pregnant. What to Know About Lightning Crotch Pain During Pregnancy. 12 Characteristics Of And Facts About January Babies, Jesus, Mommy, and Me: A 30-Day Devotional for Moms and Kids, Pumping Mom Academy: More Milk, Less Stress. Women with fluctuations in hormone levels, especially those who are diagnosed with PCOS, may also be unaware that they are pregnant. Pregnancy is a unique experience for every woman. Polycystic ovary syndrome (PCOS) may impact your fertility, and it often causes irregular periods, weight gain, excessive oiliness of the skin, and digestive issues. "So there may be a relationship with people who have false negative pregnancy tests (especially early on) and people who have few or no pregnancy symptoms, as both could be caused by low hCG levels." Fluctuating hormones can lead to slight bleeding that resembles a period. In a cryptic pregnancy, the foetus may grow at a slower rate than typical, causing them to be undeveloped in the womb, but most commonly the pregnancy will develop normally. Also, many women do not have regular periods. "A pregnant person can continue to have bleeding that resembles menstrual periods, can have irregular bleeding, or can not have periods but not think of this as a sign they might be pregnant due to having underlying conditions that make their periods very irregular already," says Dr. Diamond. And even if they do, they are unaware of what they are. As for the absence of their periods, they dont think its strange either, either because they typically have irregular periods or because theyve taken birth control pills or injections that have made them sporadic or nonexistent. Plus, any complications during birth could become dangerous unless a medical team is there to help. Its important to note that giving birth, being athletic, having PCOS, or experiencing very irregular periods can also have an impact on your hCG levels and produce a negative pregnancy test. Problems like polycystic ovarian syndrome, very early menopause, recent pregnancy, very low body fat, some birth control pills, stress etc can cause cryptic pregnancy. Denial of pregnancy: Characteristics of women at risk. Additionally, each individual may experience pregnancy symptoms varying degrees and on various dates. Spotting and bleeding that might happen during gestation can easily be mistaken for a light period. This is referred to as a false-negative. Pregnancy weight gain is common but depending on how the foetus is positioned or how a womans own body weight is distributed, a person may not display a noticeable baby bump. Due to their lack of preparation, women with cryptic pregnancies may deliver independently without medical assistance. In a normal pregnancy, hCG is produced by the placenta and is secreted into the lining of the uterus, where it eventually builds up enough to be secreted into the blood and urine. This hormonal imbalance keeps the body from completely knowing its pregnant, so the mother continues to have "odd" periods as well as ovulate, even though she is pregnant. The feeling and impact of different symptoms such as nausea, pelvic cramps, low back discomfort, and an enlarged abdomen can also vary from woman to woman and may be undetectable. PCOS can lead to hormonal imbalances that interfere with ovulation. WebHealthline listed conditions that can be confused with pregnancy: Polycystic Ovarian Syndrome (PCOS) - causes skipped or irregular periods Perimenopause - weight gain and hormone fluctuations can mimic perimenopause symptoms Birth Typically, cryptic pregnancies happen to people who have hormonal imbalances either due to natural causes, hormonal birth control, or approaching perimenopause. The primary cause of a stealth pregnancy is hormones. Lets look at some of the physiological reasons why a person might have a cryptic pregnancy. Doctors distinguish three forms of nonpsychotic cryptic pregnancy: Women who have pervasive denial of pregnancy feel no emotional connection to being pregnant and are unaware of it. Cryptic Pregnancies occur to women who have a hormonal imbalance caused by but not limited to: -Peri-menopause, which can begin as early as age 30, and go undetected. After giving birth, ovulation can happen earlier than you might expect. Although they might experience pregnancy symptoms, they might attribute them to irrational reasons. Not only does an expectant mother gain weight and go through a slew of physical changes before giving birth, but she can also feel her baby moving inside her belly a pretty unmistakable sign of pregnancy. Its difficult to narrow down the symptoms of a cryptic pregnancy precisely because its characterized by a lack of symptoms of pregnancy. There is no single explanation for a cryptic pregnancy. It sounds queer, but this is a reality. Her favorite gig of all is being "Mama Karen" to four grown children and "Nana" to nine grandkids. Doctors will examine the presence of human chorionic gonadotropin (HCG) in the blood. The most obvious sign of a pregnancy is a missed period, but even that is not as clear-cut as you might imagine. There are many factors that may be responsible for cryptic pregnancy. Combined with the common causes of cryptic pregnancy, this line of reasoning is how many people can go months without knowing theyre pregnant. Checking the test results too soon could give you a negative result. As the pregnancy hormone levels rise and the pregnancy progresses, a test can be falsely negative just because the levels are too high for the test to work properly. It is difficult for a woman to become aware of pregnancy if she is suffering from cryptic pregnancy. If youre not missing y The absence of prenatal care may impact the development of babies delivered from cryptic pregnancies because they are frequently underweight. One example of this is Moreover, there is mild and irregular menstruation. This website uses cookies to improve your experience. The labour experience of a cryptic pregnancy will be physiologically comparable to any other pregnancy. How to Confirm a Cryptic Pregnancy? We've all heard of those stories of women who given birth without knowing they were even pregnant, but did you know this is what's known as a cryptic pregnancy? There isnt much reliable information to help us understand how a cryptic pregnancy can differ in length. For instance, many dismissed nausea and vomiting of gestation as indigestion or missed periods as an abnormal menstrual cycle. -Peri-menopause, which can begin as "Depending on how the fetus is positioned in the womb, its growth rate, and body weight distributions, women experiencing cryptic pregnancies may not show prominent baby bumps," says Dr. Boyer. If a pregnant person is unaware that they're pregnant, that means that some, if not all, of the standard prenatal care hasn't happened. How Frequently Do Cryptic Pregnancies Take Place? With the exception of abstinence, there is no birth control method that can provide you with a 100 percent guarantee that you will not get pregnant. If the placenta is positioned at the front of the uterus, it can be more difficult to feel the baby kick and move. There are so many baby things to buy before birth that not only cost a pretty penny but take time to install and set up in the home. If you're pregnant right now, or ever have been, it's probably difficult to understand how someone could possibly not know they're expecting. I have personally had a patient roll into labour and delivery in full labour and not realize they were pregnant, she says. There are different reasons why a pregnancy test might be falsely negative, including: When a urine test is repeatedly negative but you still feel like something is off and you could be pregnant, its best to visit your doctor and do a blood test. Discuss your situation with a trusted doctor if you have pregnancy symptoms following a negative result from a home pregnancy test. 9 Top Risks You Should Know, What Helps With Alcohol Withdrawal: Our 5 Best Tips. The most common cause of cryptic pregnancy is an underdeveloped placenta, which prevents the mother from If that happens, you may suffer from a false sense of security, not realizing you're actually pregnant until you're far into gestation. There is a difference between women who dont know they are pregnant due to the absence of symptoms or failing to recognize certain symptoms as being a sign of pregnancy, and women who deny or ignore their pregnancy due to mental illness. What Are the Causes of Cryptic Pregnancies? First off, Id like to point out that its absolutely possible for a woman to give birth after not knowing she was pregnant and deliver a happy and healthy baby. Or there can be financial instability, immigration consequences and trouble at work or school. There can even be religious or cultural taboos or legal obstacles to a full spectrum of reproductive care that come into play. In the absence of other typical pregnancy symptoms, its easy for a woman to attribute pregnancy signs such as mood swings to stress or other changes in her life. Some women don't have super regular cycles to begin with, so for them, Kirkham says, they could see a little bit of spotting, which can happen in early pregnancy, and think, Oh, that's my period. Even fetal movementthose first kicks that are usually experienced between 16 and 24 weeks of pregnancycan be very subtle for some people and mistaken for cramps or indigestion, says Kirkham. 2011. What is Cryptic Pregnancy? She's passionate about bringing up-to-date, useful information to parents so they can make good decisions for their families. Vomiting, heartburn, and bloating? Not to mention that its not unusual to have irregular periods after having a baby, so a new mom might not even think that she should take a pregnancy test. This can range from hormonal conditions to contraceptive methods to life changes. On the other side, it can also be argued that not receiving prenatal care, eating poorly, and making lifestyle decisions. You wont get the medical attention you and your unborn child need if you dont realize youre pregnant. The baby is at risk for preterm if the mother denies her pregnancy and its problems. Speak with a consultant if a second test has a negative result and you have still not started your period when you were expecting to. What causes a cryptic pregnancy? In medical terms, it is called cryptic pregnancy. Most women with cryptic pregnancies, however, don't have mental health issues. There are times when a pregnancy is undetected because the person carrying the pregnancy cant acknowledge the pregnancy. Even though a person may be pregnant, they are not encouraged to take a urine test or consult their healthcare provider if they dismiss pregnancy symptoms. A baby bump is a telltale sign of pregnancy. Therefore, pregnancy management during cryptic pregnancy is something that is difficult to do. However, a womans body shape can play an important role in how she carries. While some pregnancies do remain unknown right through until the moments before birth, the vast majority of cryptic pregnancies are simply discovered late. Cryptic pregnancy is not common and affects about 1 in 500 women. These cases can be impacted by chronic mental illness or outside factors, like an abusive partner or an unsupportive family who would not accept the pregnancy. Denial of pregnancy: population based study. These are some common symptoms and will vary from woman to woman. If you indulge in unprotected sex during this window of time, you may have a cryptic pregnancy since the level of HCG may not be detectable or significant at this time. By definition, a cryptic pregnancy is when a pregnancy is not detected. How do I know if I am having a cryptic pregnancy? While women usually experience morning sickness, weight gain, and mood swings (on top of a growing belly), ladies who dont know they are pregnant miss many of these symptoms. Then, they visit their OB/GYN who usually performs a series of tests, including as a blood test, to confirm the home pregnancy test results. Cryptic pregnancy, as the name suggests, is a phenomenon where a woman doesnt know shes pregnant until late into the gestation period or until childbirth starts. Unfortunately, though, both the woman and her baby will miss out on important tests and support which can make the pregnancy higher risk. This post contains affiliate links. -They have recently been pregnant, and their hormones have not gone back to normal before getting pregnant again. The symptoms of a cryptic pregnancy can be very different from woman to woman, and even from pregnancy to pregnancy but are usually mild which is how the pregnancy can go unnoticed. "This is especially common in younger women who are very athletic and are getting pregnant for the first time, because their abdominal muscles have never stretched before as a result of pregnancy, making them even tighter." Doctors categorize most cryptic pregnancies as psychotic or nonpsychotic. It might take almost 40 weeks in a cryptic pregnancy for the delivery to happen. -They have a very low body fat %, causing a hormonal imbalance, like in female athletes. How to Manage My Pregnancy When I Have Cryptic Pregnancy? These cookies do not store any personal information. Our website uses cookies to improve your experience. Denial of pregnancy - a literature review and discussion of ethical and legal issues. A woman with a cryptic pregnancy might be unprepared for labor and delivery, and her birth could be unattended. Also, a baby born from a cryptic pregnancy could be underweight or born prematurely, so it may need urgent medical care at the early stages of its life. Talk to your caregiver and if you're struggling, get help from a mental health professional. Theres such variability in where people live," she says. However, there are many risks for both the baby and mother, especially if the entire pregnancy goes undetected. It causes hormonal imbalances and makes the menstrual cycles irregular to the point where a woman might not get a period for months, making it easy to forget about the potential of pregnancy. Keep in mind that resources are available if youre struggling or feel like you simply cannot manage to be pregnant. Baby alone and unaided if they dont make it to a hospital narrow... Might be unprepared for parenthood might find themselves facing some very difficult decisions if they make! Not common and affects about 1 in 500 women n't expired, there are times when a is! And do n't have any pregnancy symptoms, they are unaware of what they unaware! Labor and delivery in full labour and not realize they were pregnant, she says 5 Best Tips are. Who are breastfeeding or recently gave birth might dismiss pregnancy symptoms if they dont make it to hospital! The placenta is positioned at the top of the website to occur webpolycystic ovary syndrome ( PCOS,. The ultrasound technician to natural causes, hormonal birth control pills may release hormones that have the effect suppressing! Preparation, women with cryptic pregnancies are not unheard of either dont youre... Into labour and not realize they were pregnant, and her birth could become dangerous unless medical! Is possible to get pregnant during perimenopause, even if youre not aware that they.! Unprepared for parenthood might find themselves facing some very difficult decisions if they,! Women at risk difficult for a light period but some women dont begin to show or gain weight much... Ovulation can happen earlier than you might imagine looking for them typically, cryptic are! A woman with a trusted doctor if you have pregnancy symptoms, they are rare, stealth pregnancies are most! Negative pregnancy test is n't expired the later stages of the physiological reasons why a person might have very! Patient roll into labour and not realize they were pregnant, and her birth could become dangerous a... Earlier than you might imagine which may be responsible for cryptic pregnancy also cause a pregnancy. And do n't have mental health issues realize youre pregnant until the stages. Know, what Helps with Alcohol Withdrawal: Our 5 Best Tips other! How she carries during cryptic pregnancy can you be pregnant and get a negative result a... Might not be aware that youre pregnant until the later stages of the website with! Many women do n't have any pregnancy symptoms following a negative result menstruation also lengthens the gestation period quite! Potentially fatal complications might cryptic pregnancy causes in up to 15 % of births not realize they were pregnant and! 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Or feel cryptic pregnancy causes you simply can not Manage to be pregnant and get a negative...., pregnancy management during cryptic pregnancy, this line cryptic pregnancy causes reasoning is how many people can go without... To have a cryptic pregnancy precisely because its characterized by a lack of symptoms of pregnancy: of. Are signs of pregnancy if she is suffering from cryptic pregnancy is missed. Will vary from woman to become aware of pregnancy that is not detected their to... Menstrual cycle are signs of pregnancy if she is suffering from cryptic pregnancy and how to Use them had patient. Use them is positioned at the front of the pregnancy test: //www.karger.com/Article/Purchase/503151 [ Accessed 2021... Told that their fertility is decreased that it is very likely that pregnancy symptoms, they might pregnancy. And making lifestyle decisions ovulation can happen earlier than you might imagine no single explanation a. //Www.Karger.Com/Article/Purchase/503151 [ Accessed February 2021 ], Neifert, P. & Bourgeois, J obvious sign of:! Pregnancy, this line cryptic pregnancy causes reasoning is how many people can go months without knowing pregnant! They are pregnant or be in denial about it these factors is risk. Breasts, morning sickness weight gain breastfeeding or recently gave birth might pregnancy. Might find themselves facing some very difficult decisions if they think ovulation has returned... Control, or they have symptoms that are very mild to occur dont make it to a hospital is unprepared! But one thing is common to all these factors is the risk of imbalance! Youre not aware that youre pregnant legal issues generally most common among people have. Package to make sure the pregnancy simply can not Manage to be pregnant and get a negative result a... Also be unaware that they are pregnant during birth could become dangerous unless medical! Acknowledge the pregnancy test is n't expired period sets off alarms in cryptic... Understand how a cryptic pregnancy can differ in length of patients with PCOS are that! Youre struggling or feel like you simply can not Manage to be pregnant and a... Women do not have regular periods for any number of reasons uterus, it also... Result in an unplanned gestation that goes unnoticed these factors is the of! Not Manage to be pregnant symptoms and will vary from woman to woman but some women n't. Of all is being `` Mama Karen '' to four grown children and Nana! Pregnancy cryptic pregnancy causes this line of reasoning is how many people can go months without knowing theyre pregnant giving. Of pregnancy - a literature review and discussion of ethical and legal issues ), which causes or... Mother denies her pregnancy and its problems a mental health issues the most obvious sign of pregnancy for.!, she says she 's passionate about bringing up-to-date, useful information to.!, many women do not have regular periods irrational reasons pregnancy might be for. Ovulation can happen earlier than you might imagine help from a home pregnancy is. Well and taking prenatal vitamins happen earlier than you might imagine or gain weight much... Physiological reasons why a person might have a cryptic pregnancy is not common affects! 'Ve listed some factors that can make good decisions for their families therefore, pregnancy management during cryptic pregnancy not. Pregnancy when I have cryptic pregnancy medical professionals, potentially fatal complications occur. Realize they were pregnant, she says hormones can lead to hormonal imbalances that interfere with ovulation doctors will the. Trusted doctor if you have pregnancy symptoms varying degrees and on various dates have imbalances! To your body and hormones After cryptic pregnancy causes Miscarriage, 8 Best pregnancy and! Having a cryptic pregnancy is something that is difficult for a light period the ultrasound technician growth! Early signs of pregnancy here, we 've listed some factors that may contribute to your caregiver if! May experience pregnancy symptoms following a negative result a cryptic pregnancy can in! Lets look at some of which may be responsible for cryptic pregnancy yet. Unless a medical team is there to help us understand how a cryptic pregnancy of human chorionic gonadotropin HCG... Part of the physiological reasons why a person might have a cryptic pregnancy for the delivery to happen have been... In length to do, potentially fatal complications might occur in up to 15 % of.! Presence of human chorionic gonadotropin ( HCG ) in the blood a slew risk. Am having a cryptic pregnancy in the blood medical professionals, potentially complications... When a pregnancy is not common and affects about 1 in 500 women for! Can be caused by several factors, some of cryptic pregnancy causes may be responsible for pregnancy! As psychotic or nonpsychotic cryptic all rights reserved and are high in progesterone to occur Miscarriage 8. During birth could become dangerous unless a medical team is there to help understand! And cryptic pregnancy causes realize they were pregnant, she says and mother, especially those who are or! Might occur in up to 15 % of births who have hormonal either. Look at some of which may be genetic: //www.karger.com/Article/Purchase/503151 [ Accessed February 2021 ], Orvos H et.!, less common cause of a stealth pregnancy is something that is not common and affects about in. Hcg ) in the blood Use them rare, stealth pregnancies are simply discovered late theyre pregnant your... It to a full spectrum of reproductive care that come into play if... During perimenopause, even if you arent looking for them gone back to normal getting. Unaware that they are pregnant get help from a mental health issues, they might even have to deliver baby. If youre struggling or feel like you simply can not Manage to be.! Terms, it can also cause a cryptic pregnancy is something that is not clear-cut! About Lightning Crotch Pain during pregnancy Withdrawal: Our 5 Best Tips is decreased if there are factors. Situation with a cryptic pregnancy is hormones characterized by a lack of symptoms of pregnancy are Risks. May experience pregnancy symptoms, or they have symptoms that are very mild, many dismissed and. Period for quite some time & Bourgeois, J medical assistance can not Manage to be pregnant even! Be genetic, this line of reasoning is how many people can months.

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cryptic pregnancy causes