Cook the Pasta: Bring a large pot of salted water to a boil, add fettuccine and cook until al dente, about 8-10 minutes. Reserve ½ cup of pasta water, then drain and set aside.

Sauté the Garlic: In a skillet, melt 2 tablespoons of butter over medium heat, add minced garlic and sauté for 1-2 minutes until fragrant.

Make the Sauce: Stir in pumpkin puree and heavy cream, reduce heat to low and heat through for 3-5 minutes until thickened.

Add Cheese: Gradually whisk in Parmesan cheese until melted; adjust sauce consistency with reserved pasta water if necessary.

Combine the Pasta and Sauce: Add drained fettuccine to the sauce, toss gently and season with salt and pepper.

Serve and Garnish: Plate pasta, garnish with parsley or sage, and optionally sprinkle with toasted pumpkin seeds.