What are the potential interactions and recommended dosages for ovarian care ingredients with supplements like Selective Serotonin Reuptake Inhibitors (SSRI), Docosahexaenoic acid (DHA), vitamin D, prenatal vitamin, Vitamin C, N-acetylcysteine (NAC), and vitamin K2?

Supplement Interactions and Dosing for Ovarian Health

No Clinically Significant Drug Interactions Identified

The supplements you listed (DHA, vitamin D, vitamin C, NAC, vitamin K2, and prenatal vitamins) have no documented clinically significant interactions with SSRIs or with each other when used at recommended doses. 1, 2, 3

Recommended Dosing for Ovarian Health and Fertility

Core Prenatal/Preconception Supplementation

• Prenatal multivitamin: Continue daily throughout preconception, pregnancy, and postpartum periods 2, 4, 5
• Folic acid: 0.4 mg daily (standard); 4-5 mg daily if BMI >30 or diabetes 2, 4
• Iron: 30-60 mg elemental iron daily (45-60 mg postpartum for at least 3 months) 2, 4, 5
• Vitamin B12: 1 mg daily orally or 1 mg IM every 3 months 2

Vitamin D Dosing

• Minimum dose: 1,000 IU (40 mcg) daily to maintain serum 25-hydroxyvitamin D >50 nmol/L (20 ng/mL) 2, 6
• Start timing: Begin 2-3 months before planned conception 6
• Monitoring: Check serum 25(OH)D, calcium, phosphate, magnesium, and PTH every 6 months 6
• Evidence for ovarian reserve: Vitamin D supplementation (300,000 IU total) improved AMH levels, AFC, and decreased FSH in women with diminished ovarian reserve and vitamin D deficiency 7

DHA (Omega-3) Dosing

• Standard dose: 1 DHA capsule daily as directed in prenatal formulations 8
• Evidence: May improve clinical and embryological IVF outcomes, though optimal dosing remains unclear 9

Vitamin C Dosing

• Recommended dose: 80 mg daily (children/adolescents); 15-25 mg/kg/day (infants) 1
• Postpartum: Continue as part of comprehensive multivitamin 2

NAC (N-Acetylcysteine) Dosing

• Pregnancy/nursing: Consult healthcare professional before use 3
• Evidence for PCOS: NAC increased clinical pregnancy rates (OR 2.15) in women with PCOS, though certainty of evidence is very low 10

Vitamin K2 Dosing

• Standard dose: 90-120 μg daily; 10 mg weekly orally if deficiency noted 2
• Breastfeeding: Continue throughout lactation 2
• Important caveat: Vitamin K supplementation is essential if taking rifampicin near delivery to prevent neonatal hemorrhage 1

Calcium Supplementation

• Dose: 1,200-1,500 mg daily in divided doses (including dietary intake) 2, 6, 4
• Critical timing: Separate calcium from iron supplements by 1-2 hours, as calcium inhibits iron absorption 4

Additional Supplements with Evidence for Ovarian Health

CoQ10

• Evidence: Improves outcomes in poor ovarian responders and older women undergoing IVF; start before cycle commencement 9
• Pregnancy rate: OR 2.49 for clinical pregnancy (very low certainty evidence) 10

Melatonin

• Evidence: May benefit some IVF outcomes (OR 1.66 for clinical pregnancy), though optimal patient population and dosing unclear 9, 10

Myo-Inositol

• Evidence: Benefits women with PCOS (RR 1.52 for clinical pregnancy), though dosing regimen unclear 9, 10

L-Carnitine

• Evidence: Increased clinical pregnancy rates (OR 11.14) in women with PCOS, very low certainty evidence 10

Monitoring Schedule

Every 3 Months (Early Postpartum/Breastfeeding)

• Full blood count, serum ferritin, iron studies (transferrin saturation), serum folate, serum vitamin B12 2

Every 6 Months

• Prothrombin time/INR, serum vitamin D with calcium/phosphate/magnesium/PTH, serum protein and albumin, liver function tests, serum vitamin E, zinc, copper, selenium 2, 6

Critical Pitfalls to Avoid

• Never discontinue supplementation immediately postpartum: Nutritional demands remain elevated during breastfeeding 2, 4
• Never take calcium and iron simultaneously: Separate by 1-2 hours to prevent absorption interference 4
• Never use vitamin A in retinol form during breastfeeding: Only beta-carotene form (5,000 IU daily) to avoid toxicity 2
• Never delay vitamin D supplementation until pregnancy confirmation: Early pregnancy is critical for vitamin D-dependent processes 6
• Never assume dietary intake is sufficient: Even with optimal nutrition, dietary sources often fail to meet requirements for vitamin D, iron, and calcium 4

Special Populations

Women with BMI >30

• Increase folic acid to 4-5 mg daily 2, 6, 4
• Same vitamin D dose (≥1,000 IU daily) but require monitoring 6

Women with History of Bariatric Surgery

• Require intensive monitoring every 6 months indefinitely 2, 6
• Higher supplementation doses needed due to permanent malabsorption 2, 4
• Higher risk for fat-soluble vitamin deficiencies (A, E, K) 2