Bring a large pot of salted water to a boil. Add fettuccine and cook until al dente, about 8-10 minutes. Reserve 1/2 cup cooking water, then drain.

In a large skillet, melt 2 tablespoons of butter over medium heat. Add minced garlic and sauté for 1-2 minutes until fragrant.

Stir in pumpkin puree and heavy cream. Mix well and heat for 3-5 minutes until rich and velvety.

Gradually whisk in Parmesan cheese until melted and smooth. Adjust thickness with reserved pasta water if necessary.

Toss the drained fettuccine into the sauce, mixing gently. Season with salt and pepper to taste.

Plate the pasta and garnish with parsley or sage. Sprinkle with toasted pumpkin seeds if desired.