Bring a large pot of salted water to a rolling boil. Add fettuccine and cook according to package instructions until al dente, about 8-10 minutes. Reserve ½ cup of pasta water before draining.

In a large skillet, melt 2 tablespoons of butter over medium heat. Add finely minced garlic and sauté until fragrant, about 1 minute.

Stir in pumpkin puree and heavy cream into the skillet, mixing well. Bring to a gentle simmer over medium heat for about 3-5 minutes.

Gradually stir in freshly grated Parmesan cheese until completely melted and the sauce is creamy, about 2-3 minutes.

Add the drained fettuccine to the sauce, tossing thoroughly. Season with salt and pepper to taste.

Plate the pasta, garnishing with chopped parsley or sage and toasted pumpkin seeds. Serve immediately.