Background: Genital tuberculosis (GTB) is a form of extrapulmonary tuberculosis that specifically targets the female reproductive organs and is a significant yet under-recognized contributor to female infertility, particularly in tuberculosis-endemic regions such as India. Owing to its insidious onset and nonspecific presentation, GTB is frequently detected only during evaluation for infertility. This study was undertaken to determine the prevalence of genital tuberculosis among infertile females attending a tertiary care centre and to relate endometrial biopsy findings with sociodemographic factors. Materials and Methods: A study was conducted in the Department of Obstetrics and Gynaecology, Prasad Institute of Medical Sciences, Lucknow, on 57 infertile women of reproductive age (20–45 years) suspected of having genital tuberculosis. After informed consent and application of inclusion and exclusion criteria, detailed clinical history and examination were recorded and a premenstrual endometrial biopsy was obtained. Samples were preserved in 10% formalin, processed, and subjected to histopathological examination for features of tuberculosis. Data were analysed using SPSS version 26; the Chi-square test was applied for categorical variables, with p < 0.05 considered significant. Results: Genital tuberculosis was diagnosed in 15 of 57 women, yielding a prevalence of 26.3%. The majority of participants belonged to the 26–30 years age group (40.3%), and among GTB-positive women 40% were in this age group. More than half were from rural areas (54.4%) and belonged to the lower socioeconomic class (68.4%). Primary infertility predominated (70.2%). Menstrual irregularities (60%) and chronic pelvic pain (46.7%) were more frequent among GTB-positive women. A past history of tuberculosis was significantly associated with GTB positivity (p = 0.008), while age, residence, and socioeconomic status showed no significant association. Among GTB-positive biopsies, caseating granulomas (73.3%), Langhans giant cells (60%), endometrial atrophy (46.7%), and chronic endometritis (33.3%) were the predominant histopathological findings. Conclusion: Genital tuberculosis remains a major and underdiagnosed cause of female infertility in TB-endemic regions, with a notably high prevalence of 26.3% in the studied population. Past history of tuberculosis emerged as the only significant risk factor. Early clinical suspicion and routine histopathological screening of infertile women—particularly those with a past TB history, long-standing infertility, menstrual disturbances, or pelvic pain—are essential for timely diagnosis and prevention of irreversible reproductive tract damage.