Its actually not that hard, the reason i got the sheol was because the first time i was doing the fetus challenge run. Next I was cain, had decent items but before the boss, found a secret room with the fetus in it to. For maggy i got good items. For the last one before It lives, i was doing a Samson run, but got the ank, played and won and bluebaby and beat satatan. For the it lives run, i had issac wuth brimstone, lord of the pit, epic fetus, and a few other items make for a slow attack time, but unholy amounts of damage. I also have about 50% of the achivments for the game.