Fukuhara began playing at the age of 3 and became a professional at age 10. The following year, she became the youngest player ever to become a member of the Japanese national team. Because of her age, she has been regarded as a "child prodigy" in table tennis. At age 13, in 2002, she became the youngest-ever Japanese representative for the Asian Games. In 2003, she reached the quarter-final, losing to top-seeded Zhang Yining, in her World Championships debut in Paris. In 2004, she took part in the World Team Championships and helped Team Japan finish third.
Fukuhara qualified to participate in the 2004 Summer Olympics in the Asian zone qualifying tournament. The qualification entitled Fukuhara to compete in Athens, at the age of 15 years and 287 days, as the youngest-ever female table tennis player to debut in the Olympic Games. She reached the round of 16 in her first Olympic Games, losing to bronze medalist Kim Kyung-Ah.
In April 2005, Fukuhara replaced compatriot Aya Umemura and became the highest-ranked Japanese female on the ITTF World Ranking list. She advanced to the semifinals at the 2005 Women's World Cup, losing to Guo Yan in the semifinals but beating Tie Ya Na in the third place match.
Fukuhara was directly qualified for the 2008 Summer Olympics through world ranking. She was chosen as the national flag bearer for Japan at the Olympic Games in Beijing, China. Fukuhara teamed up with Sayaka Hirano and Haruna Fukuoka at the women's team event. They reached the bronze medal contest but lost to South Korea. In the singles event, Fukuhara advanced to round of 16, losing to gold medalist Zhang Yining.
She also qualified directly for the London 2012 Olympic Games with her world ranking in June 2011, but lost to Ding Ning on 31 July 2012, (13–15, 6–11, 6–11, and 4–11). At the Women's Team Event semi-finals, she defeated Feng Tianwei (11–9, 11–6, 5–11 and 11–9) in the first match which eventually helped Japan reach their first table tennis finals in the Olympics over Singapore. However, Japan failed to defeat China in the finals but Fukuhara got her first silver medal ever in table tennis.
Fukuhara also qualified for the 2016 Summer Olympics in Rio de Janeiro, where she lost a close semi-final against Germany with her team and later won bronze together with Kasumi Ishikawa and Mima Ito on her side by defeating the team from Singapore. She was also playing for Japan in the Singles event and reached 4th place after losing against Li Xiaoxia and losing in the game for bronze against Kim Song-i.
Ai Fukuhara won Table Tennis Women's Doubles with Kasumi Ishikawa.
The Kuwait Open 2010 would be Ai's most fruitful competition at that time. On the way to the finals, she caused numerous upsets. Starting off, she upset China by defeating Guo Yue. Later on, she played Singapore's Wang Yuegu, where Ai eventually won 4–2. After two shocking wins, Ai went on to cause another upset to China by beating the experienced top-spin specialist, Guo Yan. In the highly lauded and suspenseful final, she nearly defeated China's top seed Liu Shiwen, but lost 3–4.
Her first name, Ai, means "love" and she is often referred to as "Ai-chan" (愛ちゃん) in Japan. Her youth and talent have made her a popular sports star in Japan. Ai Fukuhara has appeared in two Japanese table tennis video games, including Ikuze! Onsen Takkyū!! (Do it! Hot Spring Table Tennis!!), released on 21 December 2001 and Fukuhara Ai No Takkyū Icchokusen (Ai Fukuhara's Table Tennis), released on 24 June 2004, both for the PlayStation 2. She carried the Olympic flame when it traveled to Tokyo in 2004. She carried the torch once again for the Beijing Olympic Games in 2008, and was the flag bearer for the Japanese national team at the Opening Ceremonies.
Since she has been playing table tennis in China from a very young age, Fukuhara can speak fluent Mandarin Chinese with a Northeastern accent. Therefore, she has greater popularity in China than most other table tennis players from outside of China. In an incident widely reported by the Chinese media, she wrote down "中日友好" (meaning "Sino-Japanese friendship" in both Chinese and Japanese) when meeting Wang Yi, then Chinese ambassador to Japan (now the Minister of Foreign Affairs), at the height of the 2005 anti-Japanese demonstrations.
In July 2005, Fukuhara guest-starred alongside Chinese actor Jackie Chan during the opening of a photograph exhibition, in Roppongi Hills, to celebrate 60 years of peaceful coexistence between China and Japan. During Chinese President Hu Jintao's visit to Japan in 2008, Hu played table tennis with Fukuhara at Waseda University.
Fukuhara attended Aomori Yamada Junior High School and graduated from Aomori Yamada High School in 2007. Both schools are located in the city of Aomori in Aomori Prefecture. In 2007, she enrolled in Waseda University's sports science department; she decided to drop out in 2010 to focus on her table tennis competitions.
Fukuhara married Taiwanese table tennis player Chiang Hung-chieh following the Rio Olympics in 2016.