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Pretty much that up until you beat Mom's Heart 11 times. After you beat the heart 11 times you will always get the choice to go to Sheol or Cathedral.
No problem. Glad to help.
You beat mom unlock the womb
Then after the womb you have to beat moms heart 11 times to unlock it lives
then once you beat it lives you unlock the cathedral and sheol
after that you have to beat Isaac 9 times to unlock the chest room.
So it takes awhile to actually beat the entire game.