The study examined pregnancy outcomes in 495 women with cesarean scar defects (CSD) and fertility desire who underwent vaginal repair (VR) between June 2014 and December 2021. After VR, 44.04% of women achieved pregnancy, with a live birth rate of 75.43%, miscarriage rate of 18.10%, and no cases of uterine rupture. Among women with previous secondary infertility, pregnancy was successful in 58.87%, and those who did conceive had a higher rate of optimal healing after surgery. Of the pregnant women with infertility, 78.31% conceived naturally, while 21.69% used IVF. Women with spontaneous pregnancy more often had menstruation shorter than 7 days and residual myometrial thickness (TRM) above 5.39 mm after VR. VR improves fertility and IVF efficiency in patients with CSD and secondary infertility, while optimal healing increases the chance of natural pregnancy.