The adverb anothen can mean again, anew, or from above depending on context. John exploits such double meanings elsewhere in the Gospel. Jesus' further language of birth from water and Spirit and of the mysterious movement of the pneuma—a word that can mean spirit, wind, or breath—moves the conversation beyond physical birth.
The precise theological relationship of 'water and Spirit' has been interpreted in several ways; the text clearly locates the required birth in God's transforming work rather than a second physical birth.