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The detrimental effects of B12 deficiencysuch as hyperhomocysteinemia and impaired methylationare well-established and can negatively impact oocyte quality and embryo viability [19, 20], which is consistent with the lower pregnancy rates we observed at low B12 levels

Three body areas provide reliable subcutaneous access for most people

Shungu DC, Weiduschat N, Murrough JW, Mao X, Pillemer S, Dyke JP, et al

Response: We appreciate commenters' concerns and the varying range of estimates provided by commenters suggests that hospitals have different operational and administrative processes and systems that impact the projected burden of encoding the new data elements and meeting the requirement to update the MRF annually