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Some people play 200,000 times and get guppy once, where others get guppy twice in a row
I dunno, a lot of things that I might not know or others might not know
First I got Guppy's Paw, then some level or two later, found a Satan Room with both Guppy's Head and Tail. I had enough hearts and soul hearts to get them, so I just did it, but Head replaced Paw on the Item slot, so I thought it was useless. When I walked out of the room, Cain transformed into Guppy, which I've never seen or used before, and it got very powerful. It got me all the way to The Chest, and I defeated ??? without a worry. Also, I got the Mama's Boy achievement without even trying. Three achievements on a single playthrough, all out of pure luck.
Of course the achievement system for this game is bugged and I had to restart Steam in order for it to recognise them, but... well, at least it did.
Note that when you beat The Chest with Cain, you'll get ???'s achievement, because this set of achievements is all messed up. Here on the wiki you can see for yourselves: http://bindingofisaac.wikia.com/wiki/Achievements
All of this just reinforces the fact that this game is not just about skill but about the luck you have finding useful items.
You can literally finish the game with almost any setup you come across.
True story.