54% but the live birth rate per cycle is about 9.5%, so people do not rely on AMH levels to recommend delaying infertility treatment 25 .
Table 1.1: Some threshold values predicting poor response of AMH
Author
Study | Size sample | Value threshold | |
Nardo et al., 2009 | Research | 165 | 1.0 |
Arce et al., 2013 | Retrospective | 749 | 1.68 |
Vuong Thi Ngoc Lan et al., 2013 | Research | 348 | 1.38 |
Vural et al., 2014 | Research | 689 | 0.62 |
Vuong Thi Ngoc Lan et al., 2016 | Research | 820 | 1.25 |
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![Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output ports bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the routers service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a routers per-hop behavior is based only on the packets marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being frozen, or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the routers buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connections shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output port's bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the router's service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a router's per-hop behavior is based only on the packet's marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being "frozen", or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the router's buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connection's shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Methods of Organizing Life Values Education Activities -
Directions for Promoting Traditional Ethical Values for Building a New Lifestyle for Students in the Current Context of Globalization -
Reference Values Drawn From Practice That Can Be Applied To Dak Mil District, Dak Nong Province
1.1.2.2. FSH concentration at the beginning of the menstrual cycle
FSH is a glycoprotein secreted from the anterior pituitary gland, acting through the hypothalamic-pituitary-ovarian axis. FSH is regulated by many factors including inhibin, activin, estradiol and follistatin 26 . When the ovarian reserve is normal, FSH is regulated by the hypothalamic-pituitary-ovarian axis, so the concentration is within normal limits. When the ovaries decrease or deplete the number of reserve eggs, the concentration of estrogen produced from the ovaries decreases, so there is no negative feedback to the hypothalamus and pituitary gland, causing the pituitary gland to increase FSH secretion. FSH concentration is quantified on days 2-4 of the menstrual cycle and is a long-standing and popular test in the assessment of ovarian reserve. Most studies use the FSH threshold value > 10 IU/L (ranging from 10 - 20 IU/L) to predict decreased ovarian reserve. The sensitivity of FSH varies widely between studies, from 10–80%, in predicting poor ovarian response and decreases with increasing patient age.
to 27 . The cutoff values used in most studies have high specificity (80-100%) but low sensitivity (10-30%) resulting in the majority of patients tested for FSH, including those with reduced ovarian reserve, will not have abnormal FSH values 13 . Although widely used, FSH has many disadvantages: FSH concentrations fluctuate between menstrual cycles and between different days of the menstrual cycle, so FSH quantification must be performed from day 2-4 of the menstrual cycle. In Broekmans's meta-analysis of 37 studies on the value of FSH in predicting poor ovarian response, it was noted that only very high FSH concentrations had relative accuracy in predicting poor ovarian response and non-pregnancy. Low FSH concentrations have no clinical value in predicting ovarian response and FSH has no value in predicting ovarian response.
Figure 1.2: FSH predicts poor response and no pregnancy 28 .
The ROC curve showed that FSH was predictive of poor response but not predictive of no pregnancy.
1.1.2.3. AFC (Antral Follicle Count)
AFC is the total number of follicles measuring 2–9 mm in both ovaries observed by transvaginal ultrasound at the beginning of the menstrual cycle. Most studies use secondary follicle size as 2–9 mm in diameter, while a few studies use 3–8 mm or 2–5 mm 29 . AFC reflects the number of secondary follicles capable of responding to FSH stimulation. AFC is noted to decrease with age 30 and is correlated with the number of primordial follicles in the ovary31 . Many studies have noted that AFC has a predictive value for response to ovarian stimulation, with thresholds ranging from 5 to 7 being predictive of poor response 32 . A recent study showed that an AFC threshold value below 5 has high sensitivity (91%) and high specificity (91%) in predicting poor response according to the criteria of less than 3 oocytes retrieved with maximum dose KTBT 33 . The AFC threshold that can be used to predict poor response in Vietnamese women is AFC < 5 23 . According to a review study by Gibreel et al. in 2009 of 17 previous studies on the use of AFC to assess ovarian reserve, the published results showed that when AFC was below 4, the risk of failure was 7-8 times higher than that of women with AFC of 4 or higher. This AFC threshold has a sensitivity of 66.7% and a specificity of 94.7%. AFC has a linear relationship with the number of retrieved oocytes and is valuable in assessing the response to IVF but has no predictive value for embryo quality, clinical pregnancy rate, or live birth rate 17 .
AFC counting depends on the skill of the sonographer, even when the same person performs the ultrasound, the results between two counts will vary. AFC values vary between menstrual cycles and between days of the menstrual cycle 34 . This variation is mainly due to changes in the number of large secondary follicles (6 – 10 mm).
1.2. Factors affecting ovarian response
The ultimate goal of ovarian stimulation is to obtain as many good quality eggs as possible. However, this depends on a number of factors:
1.2.1. Age
Women are born with a fixed number of primary follicles. The number of follicles does not increase, but only decreases over time. The older they get, the more they decrease. Population statistics show that a woman's fertility declines significantly after the age of 35 and very few women give birth after the age of 40, although menstruation only really stops around the age of 45 - 50 35 .
In a developed society, the age of marriage and having children tends to increase, women over 30 years old have an increasing need to have children and infertility treatment 36 . Age is a factor that determines natural fertility and assisted reproductive cycles, because age is one of the factors that predict ovarian reserve. However, age is not considered a cause of infertility because age reflects physiological status rather than pathological status 36 .
Advanced age reduces ovarian response to gonadotropins, reduces the number of eggs, egg quality, fertilization rate and embryo quality. The live birth rate after in vitro fertilization is 17% in women aged 30, decreasing to 7% in women aged 40 and 2% in women aged 45 37 . The age of the woman also affects the live birth rate because the older the age, the higher the miscarriage rate. The risk of miscarriage increases from 10% in women under 30, 18% in women in their late 30s and 34% in women aged 40 37 .
Year old
Number of primordial follicles
Figure 1.1. Decrease in the number of oocytes from birth to menopause 38
1.2.2. Body mass index
BMI is one of the important factors to evaluate ovarian response during ovarian stimulation, calculated by the formula: BMI = Weight (kg)/height x height (m 2 ). Many studies have shown that increased BMI requires increased FSH dose, increased number of days of ovarian stimulation, fewer eggs are obtained and is a valuable parameter to predict the number of follicles ≥ 14 mm on the day of hCG injection 39 .
1.2.3. History of pelvic surgery
Interventions in the pelvic area can cause pelvic adhesions, especially ovarian surgery that causes loss of healthy ovarian tissue, thereby reducing ovarian reserve, causing poor ovarian response and low egg retrieval . 40. History of pelvic surgery, especially ovarian surgery, is a factor that affects the results of ovarian stimulation.
1.2.4. Tests on ovarian reserve
● FSH concentration at the beginning of the menstrual cycle : is a useful and important prognostic factor. Because FSH concentration increases with age, if the FSH concentration is above 12 IU/l but especially above 20 IU/l, the response to in vitro fertilization is poor. According to research by Pearlstore et al., if the FSH concentration is above 25 IU/l or the woman is over 44 years old, the chance of pregnancy is almost zero when stimulating the ovaries or assisted reproduction 41 .
FSH concentration below 10 mIU/l is normal, from 10-15 mIU/l is the limit value, also known as the gray zone. When FSH concentration is above 15 mIU/l, it is abnormal and reduces ovarian reserve 41 .
According to studies by Scott (2001), Marcus and Brinsden (2004), Ron-EL (2000), age and FSH levels are two factors commonly used to predict ovarian response. Older patients and high FSH levels are at risk of poor response to ovarian stimulation 42–44 . However, recent studies by Nahum (2001), Ng EHY (2000), Hsieh (2001) showed that the number of antral follicles has a better predictive value for poor ovarian response than age and FSH levels, and the number of antral follicles is related to the number of retrieved oocytes 45–47 .
● Estradiol (E 2 ) concentration at the beginning of the menstrual cycle : increased E 2 concentrationat the beginning of the menstrual cycle can predict poor ovarian response despite normal FSH concentration. Most of E 2 is produced by the granulosa cells of the ovary, in addition, there is also E 2 metabolismfrom testosterone. E 2 is also produced in small amounts from the adrenal cortex, brain... 48 .
When entering the age of 40-45, the follicular phase of women is shortened to about 10.4 days compared to 16.9 days of women aged 18-20 49 . Surveys show that more follicles are recruited in the period near menopause. It is the increase in the concentration of E 2 secreted into the blood that contributes to the shortening of the follicular phase 50 .
To assess ovarian reserve, E 2 concentration test is performed on the first days of the menstrual cycle at the same time as FSH concentration test. Ovarian reserve is considered to be reduced when: FSH > 12-15 mIU/ml; E 2 > 75-80 pg/ml 51 .
● Antral follicle count (AFC): assessed by transvaginal ultrasound in the early follicular phase Patients with less than 4 antral follicles were associated with poor ovarian response and had a higher rate of cycle cancellation than patients with more than 4 antral follicles (41% vs. 6.4%), and a lower pregnancy rate (24% vs. 58%) in in vitro fertilization 52 .
Figure 1.2. AFC values by age at the 3rd, 10th, 25th, 50th, 75th, 90th, 97th percentiles 30 .
According to Muttukishna et al. in the UK (2005), the number of secondary follicles on day 3 of the cycle was significantly correlated with the number of oocytes retrieved and the clinical pregnancy rate. However, the number of secondary follicles did not predict the number of oocytes retrieved, while the ability to conceive depends on both the number of oocytes and the quality of the oocytes 53 .
● Inhibin B concentration: inhibin B is produced by granulosa cells during the development of ovarian follicles and is a more direct test than other tests of ovarian function 54 . According to Fried (2003), low inhibin B concentration on day 3 of the cycle predicts poor ovarian response before the increase in FSH concentration on day 3 of the cycle. A study on 292 patients undergoing in vitro fertilization with normal FSH concentration on day 3 of the cycle showed that inhibin B concentration is related to ovarian response including the number of follicles, number of oocytes, and number of embryos. However, inhibin B concentration is not related to pregnancy rate 54 . One possible reason is that inhibin B concentration only reflects granulosa cell function and therefore only predicts ovarian response. Inhibin B concentration < 40 mg/ml predicts poor ovarian response with a sensitivity of 87% and a specificity of 49% 54,55 .
● Anti-Mullerian hormone (AMH) concentration:
AMH is a glycoprotein secreted by the granulosa cells of the ovarian follicles. AMH levels indicate the number of follicles present in the ovary, also known as the ovarian reserve. The better the ovarian reserve, the higher the ovarian ability to produce eggs and vice versa 56 .