Genital tuberculosis is a chronic disease and often has low grade symptomatology, with very few specific complaints. Many times, genital tuberculosis is diagnosed during infertility workup in endemic geographic locations. Incidence of genital tuberculosis is directly related to prevalence of pulmonary tuberculosis in that region. Female genital tuberculosis is mostly a post-primary manifestation. In majority, the infection reaches the genital tract by the hematogenous route. Direct or lymphatic spread from the infected adjacent organs such as peritoneum, bowel and mesenteric nodes or transfer by coitus from infected male sexual partner are the other routes of spread. The tubes are involved in 90-100% cases, endometrium in 50-60%, ovaries in 20-30%, cervix in 5-24%, vagina and vulva in 1-2% of the cases. Myometrium gets involved very rarely. Genital tuberculosis has a major impact on practice of infertility. Keeping this in mind office endometrial biopsy should be first diagnostic test in endemic region on day one of menstruation cycle which can pick up granulomatous lesion and can offer a conclusive diagnosis. Liberal use of laparoscopy and hysteroscopy in the evaluation of infertility will have great potential to pick up cases in earlier stages of disease, offer conclusive medical/surgical management and improve fertility potential either by spontaneous conception or IVF-ET program. So the doom associated with Koch’s can thereby be reversed on a positive scale. Genital tuberculosis no longer remains the peril of developing countries, with spread of HIV, physicians of developed nations have to be well versed with diagnosis and management of genital tuberculosis.