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At what point was the mechanism of conception actually understood, though? Spermatzoa meets egg and all that. Until the invention of the microscope the idea tha there were discrete cells in ejaculate would have been considered witchcraft. Throughout the medieval period human dissection was not permitted, and most medical scholarship was based on surviving Greek and Roman Texts. Even the Greek Anatomist, Galen, got information wrong because he wasn't permitted human subjects, and extrapolated from animal systems.
The linkage between sex and procreation was not always completely clear, at least in humans. Animals with an obvious estrus cycle, yes, it's understood that the sexual act results in offspring some specified amount of time later, but with humans, at what point in history was that figured out? Women knew they were pregant when they felt the child move ... lack of menstrual cycle is a clue, but not a definite indicator of pregnancy. That remains the case today, actually.
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